Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, 151 Bd de l'Hôpital, 75013, Paris, France.
International Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.
Arch Orthop Trauma Surg. 2023 Jun;143(6):3587-3596. doi: 10.1007/s00402-022-04606-y. Epub 2022 Sep 9.
In hip osteoarthritis, hip flexion contracture can severely alter the patient's alignment, and, therefore, affect the patient's quality of life (QOL). Hip contracture is not well-studied, partly because of the difficulties of its diagnosis. The aim of this study was to propose a quantitative definition of hip flexion contracture, and to analyse sagittal alignment in these patients compared to non-contracture ones, before and 12 months after total hip arthroplasty (THA).
Consecutive patients with hip arthrosis and an indication for THA were included (N = 123). Sagittal full-body radiographs were acquired in free standing position and in extension. QOL questionnaires were administered before and after surgery. Spinopelvic parameters were measured, including the pelvic-femur angle (PFA). Patients with low pelvic incidence (< 45°) were included in the hip contracture group if PFA > 5°, or PFA > -5° when pelvic incidence ≥ 45°.
29% of patients were in the hip flexion contracture group, and they showed lower pelvic tilt than the no-contracture group (p < 0.001), larger lumbar lordosis (LL) and smaller PI-LL (p < 0.001), as well as a forward position of the head. 16% of patients still had hip contracture 12-months postop. Contracture patients showed higher QOL scores after surgery.
The proposed method to diagnose hip contracture group allowed to define a group of patients who showed a specific pattern of sagittal spinopelvic alignment. These patients improved their alignment and quality of life postoperatively, but their hip mobility was not always restored. Diagnosing these patients is a first step toward the development of more specific surgical approaches, aiming to improve their surgical outcome.
在髋关节骨关节炎中，髋关节屈曲挛缩会严重改变患者的对线，从而影响患者的生活质量（QOL）。髋关节挛缩尚未得到充分研究，部分原因是其诊断困难。本研究旨在提出一种髋关节屈曲挛缩的定量定义，并分析这些患者与非挛缩患者在全髋关节置换术（THA）前后的矢状面对线。
连续纳入髋关节骨关节炎且有 THA 指征的患者（N=123）。在自由站立和伸展位采集全脊柱骨盆正位片。在手术前后进行生活质量问卷评估。测量脊柱骨盆参数，包括骨盆股骨角（PFA）。低骨盆入射角（<45°）患者，如果 PFA>5°，或骨盆入射角≥45°时 PFA>-5°，则纳入髋关节屈曲挛缩组。
29%的患者存在髋关节屈曲挛缩，与无挛缩组相比，其骨盆倾斜度较小（p<0.001），腰椎前凸较大（LL）和骨盆入射角-腰椎前凸角（PI-LL）较小（p<0.001），且头部位置前倾。16%的患者术后 12 个月仍存在髋关节挛缩。挛缩患者术后生活质量评分较高。
所提出的诊断髋关节挛缩组的方法可定义一组具有特定矢状面脊柱骨盆对线模式的患者。这些患者术后对线和生活质量得到改善，但髋关节活动度并未完全恢复。诊断这些患者是制定更具体手术方法的第一步，旨在改善其手术结果。
