Shimada Tetsuro, Maeyama Akira, Ishimatsu Tetsuro, Matsunaga Taiki, Miyazaki Kotaro, Yamamoto Takuaki
Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, JPN.
Cureus. 2025 Jul 31;17(7):e89173. doi: 10.7759/cureus.89173. eCollection 2025 Jul.
Introduction Flexion contracture of the knee has been reported to induce forward trunk inclination and pelvic retroversion, whereas the progression of pelvic retroversion may further exacerbate knee joint symptoms, suggesting a close relationship between the knee and spinal alignment. The purpose of this study was to investigate the effects of lower limb alignment changes after opening wedge high tibial osteotomy (OWHTO) on spinopelvic sagittal alignment. Methods We retrospectively analyzed 34 knees that underwent OWHTO for medial compartment knee osteoarthritis between 2023 and 2025. Standing full-length lower limb and whole-spine radiographs were obtained preoperatively and at one year postoperatively. Lower limb alignment parameters, i.e., the percentage of mechanical axis (MA), mechanical medial proximal tibial angle (mMPTA), mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA), and posterior tibial slope (PTS), were evaluated. Spinopelvic parameters included pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), thoracic kyphosis (TK), lumbar lordosis (LL), and the mismatch between PI and LL (PI-LL) Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) before surgery and at one year postoperatively. Correlations between postoperative spinopelvic parameters and clinical outcomes were also examined. Results Pelvic tilt and the mismatch between PI and LL significantly decreased following OWHTO (p = 0.003 and p = 0.044, respectively), indicating improvement in spinopelvic sagittal alignment. However, no significant correlations were found between changes in spinal alignment and postoperative scores on the KOOS. Conclusion Both pelvic tilt and the mismatch between PI and LL, which reflect lumbopelvic alignment, were significantly decreased after OWHTO. This may have arisen because the correction of knee alignment improved the load distribution in the lower limbs, which in turn contributed to the improvement of lumbopelvic alignment. Our findings suggest that OWHTO not only corrects lower limb alignment but may also have a positive effect on lumbopelvic alignment.
引言 据报道，膝关节屈曲挛缩会导致躯干前倾和骨盆后倾，而骨盆后倾的进展可能会进一步加重膝关节症状，这表明膝关节与脊柱排列之间存在密切关系。本研究的目的是探讨开放性楔形高位胫骨截骨术（OWHTO）后下肢排列变化对脊柱骨盆矢状面排列的影响。方法 我们回顾性分析了2023年至2025年间因内侧间室膝关节骨关节炎接受OWHTO治疗的34例膝关节。术前和术后一年拍摄站立位全下肢和全脊柱X线片。评估下肢排列参数，即机械轴（MA）百分比、机械性胫骨近端内侧角（mMPTA）、机械性股骨远端外侧角（mLDFA）、关节线汇聚角（JLCA）和胫骨后倾（PTS）。脊柱骨盆参数包括骨盆倾斜（PT）、骶骨倾斜（SS）、骨盆入射角（PI）、胸椎后凸（TK）、腰椎前凸（LL）以及PI与LL之间的不匹配（PI-LL）。术前和术后一年使用膝关节损伤和骨关节炎疗效评分（KOOS）评估临床疗效。还检查了术后脊柱骨盆参数与临床疗效之间的相关性。结果 OWHTO后骨盆倾斜以及PI与LL之间的不匹配显著降低（分别为p = 0.003和p = 0.044），表明脊柱骨盆矢状面排列得到改善。然而，脊柱排列变化与KOOS术后评分之间未发现显著相关性。结论 OWHTO后，反映腰骶部排列的骨盆倾斜以及PI与LL之间的不匹配均显著降低。这可能是因为膝关节排列的矫正改善了下肢的负荷分布，进而有助于腰骶部排列的改善。我们的研究结果表明，OWHTO不仅能矫正下肢排列，还可能对腰骶部排列产生积极影响。
