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Toward understanding the underlying mechanisms of pelvic tilt reserve in adult spinal deformity: the role of the 3D hip orientation

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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.

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Acknowledgements

This research was funded by the University of Saint-Joseph (grant FM361) and EUROSPINE (TFR2020#22). The funding sources did not intervene in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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Authors and Affiliations

  1. Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon

    Mario Mekhael, Georges Kawkabani, Renée Maria Saliby, Eddy Saad, Elena Jaber, Rami Rachkidi, Khalil Kharrat, Gaby Kreichati, Ismat Ghanem & Ayman Assi

  2. Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France

    Wafa Skalli & Ayman Assi

  3. Department of Orthopedic surgery, Hospital for Special Surgery, New York, USA

    Virginie Lafage

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Correspondence to Ayman Assi.

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MM, GK, RMS, ES, WS, EJ, RR, KK, GK, IG, VL and AA, declare that they have no conflict of interest related to this study.

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Mekhael, M., Kawkabani, G., Saliby, R.M. et al. Toward understanding the underlying mechanisms of pelvic tilt reserve in adult spinal deformity: the role of the 3D hip orientation. Eur Spine J 30, 2495–2503 (2021). https://doi.org/10.1007/s00586-021-06778-4

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