TY - JOUR
T1 - The Influence of Knee Osteoarthritis on Spinopelvic Alignment and Global Sagittal Balance
AU - Katsumi, Ryota
AU - Mannen, Erin M.
AU - Bajaj, Gitanjali
AU - Smith, Jacob R.
AU - Mears, Simon C.
AU - Stambough, Jeffrey B.
AU - Barnes, C. Lowry
N1 - Publisher Copyright:
© 2021 Georg Thieme Verlag. All rights reserved.
PY - 2021/11/3
Y1 - 2021/11/3
N2 - Osteoarthritis (OA) of the knee is thought to lead to a loss of lumbar lordosis (LL) as a compensation for knee flexion contracture. Changes in sagittal alignment are not limited to the lumbar spine and involve a complex interplay of alignment of the hip, pelvis, and spine. While spine-hip interactions have been previously explored, the influence of knee OA sagittal alignment parameters on spinopelvic alignment and global sagittal balance remains unexplored. Standing radiological examination using EOS biplanar radiography was examined in 108 patients with knee OA. Whole-body sagittal alignment parameters (thoracic kyphosis, LL, pelvic incidence, pelvic tilt [PT], femoropelvic angle [FPA], femoral tilt angle [FTA], tibial tilt angle, and knee flexion angle [KFA]) and global balance parameters (sagittal vertical axis [SVA] and odontoid hip axis [OD-HA] angle) were measured three dimensionally (3D). The correlation coefficients among all parameters were assessed. A multiple stepwise linear regression model was built to investigate the direct association between SVA or OD-HA angle (dependent variables) and sagittal alignment parameters and demographic data (independent variables). Significant correlations between KFA, FPA, FTA, SVA, and OD-HA angle were found. FTA was correlated with LL and FPA. The FTA was the most influential predictor of both global sagittal balance parameters (p < 0.001). Knee OA leads to changes in global sagittal balance with effects at the hip, knee, pelvis, and spine. FTA (forward flexion of the femur vs. the vertical plane) is the largest driver of global sagittal plane balance in patients with knee OA.
AB - Osteoarthritis (OA) of the knee is thought to lead to a loss of lumbar lordosis (LL) as a compensation for knee flexion contracture. Changes in sagittal alignment are not limited to the lumbar spine and involve a complex interplay of alignment of the hip, pelvis, and spine. While spine-hip interactions have been previously explored, the influence of knee OA sagittal alignment parameters on spinopelvic alignment and global sagittal balance remains unexplored. Standing radiological examination using EOS biplanar radiography was examined in 108 patients with knee OA. Whole-body sagittal alignment parameters (thoracic kyphosis, LL, pelvic incidence, pelvic tilt [PT], femoropelvic angle [FPA], femoral tilt angle [FTA], tibial tilt angle, and knee flexion angle [KFA]) and global balance parameters (sagittal vertical axis [SVA] and odontoid hip axis [OD-HA] angle) were measured three dimensionally (3D). The correlation coefficients among all parameters were assessed. A multiple stepwise linear regression model was built to investigate the direct association between SVA or OD-HA angle (dependent variables) and sagittal alignment parameters and demographic data (independent variables). Significant correlations between KFA, FPA, FTA, SVA, and OD-HA angle were found. FTA was correlated with LL and FPA. The FTA was the most influential predictor of both global sagittal balance parameters (p < 0.001). Knee OA leads to changes in global sagittal balance with effects at the hip, knee, pelvis, and spine. FTA (forward flexion of the femur vs. the vertical plane) is the largest driver of global sagittal plane balance in patients with knee OA.
KW - knee flexion contracture
KW - knee osteoarthritis
KW - knee-spine syndrome
KW - lumbar lordosis
KW - sagittal alignment
KW - spinal deformity
UR - http://www.scopus.com/inward/record.url?scp=85164041744&partnerID=8YFLogxK
U2 - 10.1055/s-0042-1747947
DO - 10.1055/s-0042-1747947
M3 - Article
C2 - 35605970
AN - SCOPUS:85164041744
SN - 1538-8506
VL - 36
SP - 917
EP - 924
JO - Journal of Knee Surgery
JF - Journal of Knee Surgery
IS - 9
ER -