Weidow J, Mars I, Kärrholm J
Department of Orthopaedics, Sahlgren University Hospital, 413 45 Göteborg, Sweden.
Osteoarthritis Cartilage. 2005 Jun;13(6):471-7. doi: 10.1016/j.joca.2005.01.009.
We evaluated if increased risk of combined hip and lateral knee osteoarthritis (OA) could be attributed to anatomical reasons in the hip region resulting in increased abductor moment over the knee.
We measured pelvic width, femoral offset, femoral neck length and angle in 29 women with lateral knee OA (13 unilateral, 16 bilateral) and 27 women with bilateral medial OA. Twenty-one of these patients with normal hips (lateral/medial OA of the knee=12/9) and 35 with associated hip OA (lateral/medial OA of the knee=17/18) were evaluated separately. Radiographic examinations in 14 women planned for hip prosthesis because of failures after hip fracture acted as controls.
Patients with lateral OA of the knee had wider pelvis than controls (13.7 mm increased distance between the medial borders of the acetabulum, P=0.001). Patients with medial OA had 11.4mm longer distance from the centre of the femoral head to the centre of the proximal part of the femoral shaft (P=0.005), corresponding to a higher offset. The pelvic and hip anatomy also differed between patients with medial and lateral OA of the knee. In the groups without hip OA, presence of lateral knee OA was associated with a wider pelvis (P=0.009), shorter femoral neck (P=0.02) and Head-Shaft distance (P=0.04). In the groups with OA of the hip associated lateral OA of the knee also implied increased Neck Shaft angle (coxa valga, P=0.008), but there was no difference in pelvic width (P=0.15). We found a shorter lever arm over the hip in lateral knee OA compared to medial knee OA (P=0.02), but not when compared to controls.
Our findings suggest that occurrence of medial or lateral OA has a biomechanical background originating from pelvis and hip anatomy.
我们评估了髋部和外侧膝关节骨关节炎（OA）合并风险增加是否可归因于髋部区域的解剖学原因，从而导致膝关节外展力矩增加。
我们测量了29例外侧膝关节OA患者（13例单侧，16例双侧）和27例双侧内侧OA患者的骨盆宽度、股骨偏心距、股骨颈长度和角度。其中21例髋关节正常的患者（膝关节外侧/内侧OA = 12/9）和35例合并髋关节OA的患者（膝关节外侧/内侧OA = 17/18）分别进行了评估。14例因髋部骨折后失败而计划进行髋关节置换的女性患者的影像学检查作为对照。
外侧膝关节OA患者的骨盆比对照组更宽（髋臼内侧边界之间的距离增加13.7 mm，P = 0.001）。内侧OA患者从股骨头中心到股骨干近端中心的距离长11.4 mm（P = 0.005），对应更高的偏心距。膝关节内侧和外侧OA患者的骨盆和髋部解剖结构也有所不同。在无髋关节OA的组中，外侧膝关节OA的存在与更宽的骨盆（P = 0.009）、较短的股骨颈（P = 0.02）和头-干距离（P = 0.04）相关。在合并髋关节OA的组中，膝关节外侧OA还意味着颈干角增加（髋外翻，P = 0.008），但骨盆宽度无差异（P = 0.15）。我们发现，与内侧膝关节OA相比，外侧膝关节OA患者髋部的力臂更短（P = 0.02），但与对照组相比无差异。
我们的研究结果表明，内侧或外侧OA的发生具有源于骨盆和髋部解剖结构的生物力学背景。
