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Sagittal Alignment of the Spine-Pelvis-Lower Extremity Axis in Patients with Severe Knee Osteoarthritis

by MASS4D® Prescription Orthotics October 30, 2016


The present study investigated the static sagittal alignment of patients suffering from knee osteoarthritis (KOA) to explore compensatory mechanisms in this population, and to determine if the sagittal alignment was associated with secondary lower back pain (LBP).

Patients who met the following criteria were recruited for the study: diagnosis of primary KOA, ambulatory without assistance, normal muscle strength in the lower extremity, and no leg-length discrepancy.

Posterior-anterior and lateral digital radiographs of the spine, pelvis and proximal femur were taken using a standard protocol with the subject standing upright.

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Comparisons of participant ages and radiographic parameters between healthy controls and patients were performed using independent samples t-tests.

Significant abnormal sagittal spine-pelvis-lower extremity alignment was identified in patients with severe KOA compared with asymptomatic controls.

Patients with severe KOA showed a knee valgus or varus, flexed hip, and higher risk of global imbalance than control subjects.

Compared with healthy controls, patients with FI ⩽ 10° showed less lumbar lordosis (LL) and more forward inclination of spine but comparable pelvic alignment, suggesting that the compensation was mainly contributed by the lumbar spine.

In contrast, patients with FI >10° showed significant forward spinal inclination, hip flexion, and pelvic anteversion but comparable LL versus controls.

It was concluded that changes in sagittal spinopelvic alignment in severe KOA patients with FI > 10° were mainly a result of hip flexion and pelvic anteversion.

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  1. Wang W.J., Liu F., Zhu Y.W., Sun M.H., Qiu Y., Weng W.J. (2016) Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis: A radiographic study. Bone & Joint Research: May 2016, Vol. 5, No. 5, pp. 198-205. doi: 10.1302/2046-3758.55.2000538.

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