Impact of Hip and Knee Osteoarthritis on Full Body Sagittal Alignment and Compensation for Sagittal Spinal Deformity

Author:

Balmaceno-Criss Mariah1,Lafage Renaud2,Alsoof Daniel1,Daher Mohammad1,Hamilton D. Kojo3,Smith Justin S.4,Eastlack Robert K.5,Fessler Richard G.6,Gum Jeffrey L.7,Gupta Munish C.8,Hostin Richard9,Kebaish Khaled M.10,Klineberg Eric O.11,Lewis Stephen J.12,Line Breton G.13,Nunley Pierce D.14,Mundis Gregory M.5,Passias Peter G.15,Protopsaltis Themistocles S.15,Buell Thomas3,Scheer Justin K.16,Mullin Jeffrey P.17,Soroceanu Alex18,Ames Christopher P.16,Lenke Lawrence G.19,Bess Shay13,Shaffrey Christopher I.20,Schwab Frank J.2,Lafage Virginie2,Burton Douglas C.21,Diebo Bassel G.1,Daniels Alan H.1,

Affiliation:

1. Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, Rhode Island, USA

2. Department of Orthopedic Surgery, Northwell, New York, NY

3. Department of Neurological Surgery, University of Pittsburgh

4. University of Virginia Health System, Charlottesville, VA

5. San Diego Spine, La Jolla, CA

6. Department of Neurological Surgery, Rush University Medical School, Chicago, IL

7. Leatherman Spine Center, Louisville, KY

8. Washington University in St Louis, St. Louis, MO

9. Department of Orthopaedic Surgery, Baylor Scoliosis Center, TX, US

10. Johns Hopkins University School of Medicine, Baltimore, MD

11. Department of Orthopaedic Surgery, University of Texas Health, Houston TX, USA

12. Division of Orthopaedics, Toronto Western Hospital, Toronto, Canada

13. Denver International Spine Center, Denver, Colorado, USA

14. Spine Institute of Louisiana, Shreveport, LA

15. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NY, USA

16. Department of Neurosurgery, University of California, San Francisco, CA, USA

17. Department of Neurosurgery, University of Buffalo, NY, USA

18. Department of Orthopedic Surgery, University of Calgary, Canada

19. Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY

20. Department of Orthopedic Surgery, Duke University, Durham, NC

21. Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA

Abstract

Study Design. Retrospective review of prospectively collected data. Objective. To investigate the effect of lower extremity osteoarthritis on sagittal alignment and compensatory mechanisms in adult spinal deformity (ASD). Background. Spine, hip, and knee pathologies often overlap in ASD patients. Limited data exists on how lower extremity osteoarthritis impacts sagittal alignment and compensatory mechanisms in ASD. Methods. 527 pre-operative ASD patients with full body radiographs were included. Patients were grouped by Kellgren-Lawrence grade of bilateral hips and knees and stratified by quartile of T1-Pelvic Angle (T1PA) severity into low-, mid-, high-, and severe-T1PA. Full body alignment and compensation were compared across quartiles. Regression analysis examined the incremental impact of hip and knee osteoarthritis severity on compensation. Results. The mean T1PA for low-, mid-, high-, and severe-T1PA groups was 7.3°, 19.5°, 27.8°, 41.6°, respectively. Mid-T1PA patients with severe hip osteoarthritis had an increased sagittal vertical axis and global sagittal alignment (P<0.001). Increasing hip osteoarthritis severity resulted in decreased pelvic tilt (P=0.001) and sacrofemoral angle (P<0.001), but increased knee flexion (P=0.012). Regression analysis revealed with increasing T1PA, pelvic tilt correlated inversely with hip osteoarthritis and positively with knee osteoarthritis (r2=0.812). Hip osteoarthritis decreased compensation via sacrofemoral angle (β-coefficient=−0.206). Knee and hip osteoarthritis contributed to greater knee flexion (β-coefficients=0.215, 0.101; respectively). For pelvic shift, only hip osteoarthritis significantly contributed to the model (β-coefficient=0.100). Conclusions. For the same magnitude of spinal deformity, increased hip osteoarthritis severity was associated with worse truncal and full body alignment with posterior translation of the pelvis. Patients with severe hip and knee osteoarthritis exhibited decreased hip extension and pelvic tilt, but increased knee flexion. This examines sagittal alignment and compensation in ASD patients with hip and knee arthritis and may help delineate whether hip and knee flexion is due to spinal deformity compensation or lower extremity osteoarthritis.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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