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Investigating sagittal spinopelvic alignment and equivalent stress on the femoral head in patients with rapidly destructive coxarthrosis

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Abstract

Purpose

Rapidly destructive coxarthrosis (RDC) is a rare syndrome of unknown etiology. This study evaluated sagittal spinopelvic alignment (SSPA) in patients with RDC and compared it with that in patients with hip osteoarthritis (HOA). In addition, finite element analysis (FEA) was performed to investigate the distribution of stress on the femoral head in RDC versus HOA.

Methods

This retrospective study included patients who had undergone primary total hip arthroplasty for RDC (n = 33) and HOA (n = 99; age- and sex-matched to patients with RDC) at three hospitals from June 2014 to September 2020. Preoperative SSPA parameters and inflammatory blood markers were compared between the two groups. FEA on the computed tomography data was performed for four patients from each group with similar pelvic tilt (PT) and lateral center–edge angle (LCEA). The distribution of Drucker–Prager equivalent stress was assessed at the loaded area of the femoral head.

Results

Patients with RDC had significantly higher PT, lower sacral slope, decreased lumbar lordosis (LL), higher sagittal vertical axis, and higher pelvic incidence minus LL than patients with HOA, indicating sagittal spinal imbalance. Blood test revealed patients with RDC had higher levels of inflammation markers than patients with HOA. FEA revealed no statistically significant difference in the degree of stress concentration or the maximum equivalent stress between the two groups when PT and LCEA were comparable.

Conclusion

Patients with RDC tend to have sagittally imbalanced spine. Decreased acetabular coverage of the femoral head may heighten mechanical load of the hip joint in patients with RDC.

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Data availability

The datasets analyzed in this study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors would like to thank Hideyuki Mimata, Research Center of Computational Mechanics, Inc. for their technical advice on FEM analysis.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan

    Kazuki Orita, Yaichiro Okuzu, Takayoshi Shimizu, Koji Goto, Yutaka Kuroda, Toshiyuki Kawai & Shuichi Matsuda

  2. Department of Orthopaedic Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

    Yaichiro Okuzu

  3. Department of Orthopaedic Surgery, Nagahama City Hospital, Nagahama, Japan

    Koji Goto

  4. Department of Orthopaedic Surgery, Kindai University Hospital, Osaka, Japan

    Koji Goto

Authors
  1. Kazuki Orita
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  2. Yaichiro Okuzu
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  3. Takayoshi Shimizu
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  4. Koji Goto
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  5. Yutaka Kuroda
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  6. Toshiyuki Kawai
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  7. Shuichi Matsuda
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Contributions

KO and YO collected and interpreted the patient data. KO were major contributors in writing the manuscript. TS, TK, YK, KG, and SM were involved in report design, critically revised the report, and commented on drafts of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yaichiro Okuzu.

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Conflict of interest

Shuichi Matsuda has received speaker and consultant honoraria from Kyocera. Other authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Kyoto University approved this study.

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Informed consent was waived in this study.

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Orita, K., Okuzu, Y., Shimizu, T. et al. Investigating sagittal spinopelvic alignment and equivalent stress on the femoral head in patients with rapidly destructive coxarthrosis. Eur J Orthop Surg Traumatol 34, 901–908 (2024). https://doi.org/10.1007/s00590-023-03733-5

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