Spinopelvic Compensatory Mechanisms for Reduced Hip Motion (ROM) in the Setting of Hip Osteoarthritis

Buckland, Aaron J.; Steinmetz, Leah; Zhou, Peter L.; Vasquez-Montes, Dennis; Kingery, Matthew T.; Stekas, Nicholas; Ayres, Ethan W.; Varlotta, Christopher; Lafage, Virginie; Lafage, Renaud; Errico, Thomas J.; Passias, Peter G.; Protopsaltis, Themistocles S.; Vigdorchik, Jonathan M.

doi:10.1016/j.jspd.2019.03.007

Cited by 42 publications

(43 citation statements)

References 34 publications

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“…Post tetanic spine deformity in the form of kyphosis was reported in an old case report by A. G. Quinlan [15]; he explained the occurrence of the deformity by the multiple vertebral crush fractures due to spasmodic hyperextension caused by tetanus. However, in the current case, spinal deformity may had occurred as a compensatory mechanism to the stiff pelvis caused by the bilaterally ankylosed hip [16].…”

Section: Discussionmentioning

confidence: 66%

Neglected reactive arthritis complicated by bilateral hip and temporomandibular joints ankylosis after a suspected tetanus infection: a case report

et al. 2021

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Background Reactive arthritis had been reported to occur after various vaccinations, including the tetanus toxoid vaccine; here, we report a case of ankylosing arthropathy suggested to be a complication of missed neglected reactive arthritis after tetanus infection. Case presentation A healthy 20-year-old woman presented with subtrochanteric right femoral fracture; imaging studies showed bilateral ankylosed hip, kyphoscoliosis, bilateral fused temporomandibular joints, and normal sacroiliac joints bilaterally. Laboratory investigations for a rheumatic or autoimmune disease were all within normal ranges. Detailed history revealed admission of the patient to an ICU unit (1 year before the trauma) for a month as she was diagnosed as having tetanus infection, after which she was unable to walk or feed herself. At the final follow-up, the patient started walking with a moderate limb after having a series of surgeries including femoral fracture fixation, temporomandibular joint excision arthroplasty, and bilateral total hip arthroplasty. Conclusion Unusual complications after tetanus infection can occur in the form of joint ankylosis, which could be presented after prolonged immobilization possibly due to improper management of reactive arthritis.

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Section: Discussionmentioning

confidence: 66%

Neglected reactive arthritis complicated by bilateral hip and temporomandibular joints ankylosis after a suspected tetanus infection: a case report

et al. 2021

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“…During the standing-up motion, anterior movement of the center of gravity is necessary to complete the motion, and hip flexion, decreased LL, and increased thoracic kyphosis contributed to this center of gravity shift [12]. In this patient, spinal movements played the main role in this gravity center shift because of limited hip flexion [14]. This compensatory mechanism probably became dysfunctional after the long spinopelvic fixation procedure.…”

Section: Discussionmentioning

confidence: 75%

Unexpected Complications after Corrective Spinal Fusion Surgery for Adult Spinal Deformity with Severe Hip Contracture

Yoshikawa¹,

Toura²,

Kudo³

et al. 2021

JOCR

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Introduction: In cases with markedly decreased hip function, patients predominantly utilize spine movement while standing up to compensate for the hip malfunction. However, spinal fusion surgeries might lead to the disruption of this compensatory mechanism, resulting in difficulties in walking and standing up as well as proximal junctional failure (PJF) due to the excessive stress on the spine caused by the pendulum-like motion needed for standing up. Hence, in patients with severe hip pathology, surgeons should be cautious about the indication for spinal fusion, which inevitably affects spinal mobility. This is the first report presenting a case that supports the aforementioned theory. Case Report: In this study, we report the case of a 76-year-old Japanese woman who underwent corrective spinal fusion surgery for spinal scoliosis secondary to hip contracture. The patient exhibited post-operative complications, such as unexpected difficulty in walking and standing up and PJF. The patient underwent a revision spinal surgery with an extension of spinal fusion for PJF and muscle release around the hip for hip contracture which resulted in improved walking and standing movements with no reports of pain. Conclusion: Spinal fusion surgeries performed on patients with severe hip pathology could cause early PJFs and unexpected decline in activities of daily living. Patients with such risks often do not complain of hip symptoms before spinal correction surgery. Surgeons should routinely evaluate hip joints and be cautious about the indication for spinal fusion which inevitably affects spinal mobility. Keywords: Hip joint contracture, spinal correction surgery, proximal junctional failure, muscle release around the hip.

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“…There were remarkable associations among spine, pelvis, and hip joints, namely compensatory mechanism in previous studies [17][18][19] . Moreover, those associated effects were notable during position changing 20,21 .…”

Section: Introductionmentioning

confidence: 83%

Correlation of Acetabular Anteversion and Thoracic Kyphosis Postoperatively with Proximal Junctional Failure in Adult Spinal Deformity Fused to Pelvis

Zhang

Wang

et al. 2021

Orthopaedic Surgery

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Objectives: To investigate whether the immediate thoracic kyphosis (TK) and acetabular anteversion (AA) postoperatively are correlated with proximal junctional failure (PJF) in adult spinal deformity (ASD) patients underwent surgical treatment.Methods: This is a retrospective study. Following institutional ethics approval, a total of 57 patients (49 Female, eight Male) with ASD underwent surgery fused to sacroiliac bone (S1, S2, or ilium) from March 2014 to January 2019 were included. All of those patients were followed up for at least 2 years. Demographic, radiographic and surgical data were recorded. The maximum range of flexion motion (F-ROM) and extension motion (E-ROM) actively of hip joints was measured and recorded at pre-and postoperation. The sum of F-ROM and E-ROM was defined as the range of hip motion (H-ROM). Receiver operating characteristic (ROC) curve analysis was used to obtain the cut off value of parameters for PJF. A Kaplan-Meier curve and log-rank test were used to analyze the differences in PJF-free survival.Results: In all, 14 patients developed PJF during follow-up. Comparisons between patients with and without PJF showed significant differences in immediate TK (P < 0.001) and AA (P = 0.027) postoperatively. ROC curve analysis determined an optimal threshold of 13 for immediate AA postoperatively (sensitivity = 74.3%, specificity = 85.7%, area under the ROC curve [AUC] = 0.806, 95% CI [0.686-0.926]). Nineteen patients with post-AA ≤13 were assigned into the observational group, and 38 patients with post-AA >13 were being as the control group. Patients in the observational group had smaller H-ROM (P = 0.016) and F-ROM (P < 0.001), but much larger E-ROM (P < 0.001). There were 10 patients showing PJF in the observational group and four in the control group (10/9 vs 4/34, P < 0.001). PJF-free survival time significantly decreased in the observational group (P = 0.001, log-rank test). Furthermore, patients in the observational group had much larger TK (post-TK, P = 0.015). The optimal threshold for post-TK (sensitivity = 85.7%, specificity = 76.7%; AUC = 0.823, 95% CI [0.672-0.974]) was 28.1 after the ROC curve was analyzed. In the observational group, those patients with post-TK ≥28.1 had significantly higher incidence of PJF (9/2 vs 1/7, P < 0.001) than those with post-TK < 28.1 . Moreover, PJF-free survival time in those patients significantly decreased (P = 0.001, log-rank test).Conclusions: ASD patients with acetabular anteversion of ≤13 at early postoperation may suffer significantly restricted hip motion and much higher incidence of PJF during follow-up, moreover, in those patients, postoperative TK ≥28.1 would be a significant risk factor for PJF developing.

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Spinopelvic Compensatory Mechanisms for Reduced Hip Motion (ROM) in the Setting of Hip Osteoarthritis

Cited by 42 publications

References 34 publications

Neglected reactive arthritis complicated by bilateral hip and temporomandibular joints ankylosis after a suspected tetanus infection: a case report

Neglected reactive arthritis complicated by bilateral hip and temporomandibular joints ankylosis after a suspected tetanus infection: a case report

Unexpected Complications after Corrective Spinal Fusion Surgery for Adult Spinal Deformity with Severe Hip Contracture

Correlation of Acetabular Anteversion and Thoracic Kyphosis Postoperatively with Proximal Junctional Failure in Adult Spinal Deformity Fused to Pelvis

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