Thummala Abhinav R, Xi Yin, Middleton Emily, Kohli Ajay, Chhabra Avneesh, Wells Joel
University of Texas Southwestern Medical School, Dallas, Texas, USA.
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Bone Joint J. 2022 Sep;104-B(9):1025-1031. doi: 10.1302/0301-620X.104B9.BJJ-2022-0095.R1.
Pelvic tilt is believed to affect the symptomology of osteoarthritis (OA) of the hip by alterations in joint movement, dysplasia of the hip by modification of acetabular cover, and femoroacetabular impingement by influencing the impingement-free range of motion. While the apparent role of pelvic tilt in hip pathology has been reported, the exact effects of many forms of treatment on pelvic tilt are unknown. The primary aim of this study was to investigate the effects of surgery on pelvic tilt in these three groups of patients.
The demographic, radiological, and outcome data for all patients operated on by the senior author between October 2016 and January 2020 were identified from a prospective registry, and all those who underwent surgery with a primary diagnosis of OA, dysplasia, or femoroacetabular impingement were considered for inclusion. Pelvic tilt was assessed on anteroposterior (AP) standing radiographs using the pre- and postoperative pubic symphysis to sacroiliac joint (PS-SI) distance, and the outcomes were assessed with the Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and Harris Hip Score (HHS).
The linear regression model revealed a significant negative predictive association between the standing pre- and postoperative PS-SI distances for all three groups of patients (all p < 0.001). There was a significant improvement in all three outcome measures between the pre- and postoperative values (p < 0.05).
There is a statistically significant decrease in pelvic tilt after surgery in patients with OA of the hip, dysplasia, and femoroacetabular impingement. These results confirm that surgery significantly alters the pelvic orientation. Pelvic tilt significantly decreased after total hip arthroplasty, periacetabular osteotomy, and arthroscopy/surgical hip dislocation. The impact of surgery on pelvic tilt should be considered within the therapeutic plan in order to optimize pelvic orientation in these patients.Cite this article: 2022;104-B(9):1025-1031.
骨盆倾斜被认为会通过关节运动的改变影响髋关节骨关节炎（OA）的症状学，通过改变髋臼覆盖影响髋关节发育不良，以及通过影响无撞击活动范围影响股骨髋臼撞击症。虽然骨盆倾斜在髋关节病理中的明显作用已有报道，但许多治疗方式对骨盆倾斜的确切影响尚不清楚。本研究的主要目的是调查手术对这三组患者骨盆倾斜的影响。
从前瞻性登记处识别2016年10月至2020年1月期间由资深作者进行手术的所有患者的人口统计学、放射学和结果数据，所有以OA、发育不良或股骨髋臼撞击症为主要诊断接受手术的患者均被纳入。使用术前和术后耻骨联合至骶髂关节（PS-SI）距离在前后位（AP）站立位X线片上评估骨盆倾斜，并使用髋关节结果评分（HOS）、国际髋关节结果工具（iHOT-12）和Harris髋关节评分（HHS）评估结果。
线性回归模型显示，所有三组患者站立位术前和术后PS-SI距离之间存在显著的负向预测关联（所有p<0.001）。术前和术后值之间的所有三项结果测量均有显著改善（p<0.05）。
髋关节OA、发育不良和股骨髋臼撞击症患者术后骨盆倾斜有统计学意义的降低。这些结果证实手术显著改变了骨盆方向。全髋关节置换术、髋臼周围截骨术以及关节镜检查/手术性髋关节脱位后骨盆倾斜显著降低。在治疗计划中应考虑手术对骨盆倾斜的影响，以便优化这些患者的骨盆方向。引用本文：2022；104-B(9):1025-1031。
