Mario Mekhael1, Georges Kawkabani1, Renée Maria Saliby1, Wafa Skalli2, Eddy Saad1, Elena Jaber1, Rami Rachkidi1, Khalil Kharrat1, Gaby Kreichati1, Ismat Ghanem1, Virginie Lafage3, Ayman Assi4,5. 1. Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon. 2. Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France. 3. Department of Orthopedic surgery, Hospital for Special Surgery, New York, USA. 4. Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon. ayman.assi@usj.edu.lb. 5. Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France. ayman.assi@usj.edu.lb.
Abstract
PURPOSE: To explore 3D hip orientation in standing position in subjects with adult spinal deformity (ASD) presenting with different levels of compensatory mechanisms. METHODS: Subjects with ASD (n = 159) and controls (n = 68) underwent full-body biplanar X-rays with the calculation of 3D spinopelvic, postural and hip parameters. ASD subjects were grouped as ASD with knee flexion (ASD-KF) if they compensated by flexing their knees (knee flexion ≥ 5°), and ASD with knee extension (ASD-KE) otherwise (knee flexion < 5°). Spinopelvic, postural and hip parameters were compared between the three groups. Univariate and multivariate analyses were then computed between spinopelvic and hip parameters. RESULTS: ASD-KF had higher SVA (67 ± 66 mm vs. 2 ± 33 mm and 11 ± 21 mm), PT (27 ± 14° vs. 18 ± 9° and 11 ± 7°) and PI-LL mismatch (20 ± 26° vs - 1 ± 18° and - 13 ± 10°) when compared to ASD-KE and controls (all p < 0.05). ASD-KF also had a more tilted (34 ± 11° vs. 28 ± 9° and 26 ± 7°), anteverted (24 ± 6° vs. 20 ± 5° and 18 ± 4°) and abducted (59 ± 6° vs. 57 ± 4° and 56 ± 4°) acetabulum, with a higher posterior coverage (100 ± 6° vs. 97 ± 7° for ASD-KE) when compared to ASD-KE and controls (all p < 0.05). The main determinants of acetabular tilt, acetabular abduction and anterior acetabular coverage were PT, SVA and LL (adjusted R2 [0.12; 0.5]). CONCLUSIONS: ASD subjects compensating with knee flexion have altered hip orientation, characterized by increased posterior coverage (acetabular anteversion, tilt and posterior coverage) and decreased anterior coverage which can together lead to posterior femoro-acetabular impingement, thus limiting pelvic retroversion. This underlying mechanism could be potentially involved in the hip-spine syndrome.
PURPOSE: To explore 3D hip orientation in standing position in subjects with adult spinal deformity (ASD) presenting with different levels of compensatory mechanisms. METHODS: Subjects with ASD (n = 159) and controls (n = 68) underwent full-body biplanar X-rays with the calculation of 3D spinopelvic, postural and hip parameters. ASD subjects were grouped as ASD with knee flexion (ASD-KF) if they compensated by flexing their knees (knee flexion ≥ 5°), and ASD with knee extension (ASD-KE) otherwise (knee flexion < 5°). Spinopelvic, postural and hip parameters were compared between the three groups. Univariate and multivariate analyses were then computed between spinopelvic and hip parameters. RESULTS: ASD-KF had higher SVA (67 ± 66 mm vs. 2 ± 33 mm and 11 ± 21 mm), PT (27 ± 14° vs. 18 ± 9° and 11 ± 7°) and PI-LL mismatch (20 ± 26° vs - 1 ± 18° and - 13 ± 10°) when compared to ASD-KE and controls (all p < 0.05). ASD-KF also had a more tilted (34 ± 11° vs. 28 ± 9° and 26 ± 7°), anteverted (24 ± 6° vs. 20 ± 5° and 18 ± 4°) and abducted (59 ± 6° vs. 57 ± 4° and 56 ± 4°) acetabulum, with a higher posterior coverage (100 ± 6° vs. 97 ± 7° for ASD-KE) when compared to ASD-KE and controls (all p < 0.05). The main determinants of acetabular tilt, acetabular abduction and anterior acetabular coverage were PT, SVA and LL (adjusted R2 [0.12; 0.5]). CONCLUSIONS: ASD subjects compensating with knee flexion have altered hip orientation, characterized by increased posterior coverage (acetabular anteversion, tilt and posterior coverage) and decreased anterior coverage which can together lead to posterior femoro-acetabular impingement, thus limiting pelvic retroversion. This underlying mechanism could be potentially involved in the hip-spine syndrome.
Authors: Gregory W Poorman; Peter G Passias; Aaron J Buckland; Cyrus M Jalai; Michael Kelly; Daniel M Sciubba; Brian J Neuman; D Kojo Hamilton; Amit Jain; Bassel Diebo; Virginie Lafage; Shay Bess; Eric O Klineberg Journal: Spine (Phila Pa 1976) Date: 2017-08-01 Impact factor: 3.468
Authors: Bassel G Diebo; Neil V Shah; Oheneba Boachie-Adjei; Feng Zhu; Dominique A Rothenfluh; Carl B Paulino; Frank J Schwab; Virginie Lafage Journal: Lancet Date: 2019-07-11 Impact factor: 79.321
Authors: I Hovorka; P Rousseau; N Bronsard; M Chalali; M Julia; M Carles; N Amoretti; P Boileau Journal: Rev Chir Orthop Reparatrice Appar Mot Date: 2008-05-12