Abstract
BackgroundThe impact of high dislocated dysplastic hips on spinal-pelvic alignment has not been well described. This study aims to evaluate compensatory spinal radiographic changes and presence of back pain in patients with Crowe type IV developmental dysplasia of the hip (DDH).MethodsAn observational study was conducted from July 2016 to December 2017, and 49 consecutive patients with Crowe IV DDH were enrolled. Forty-nine sex- and age-matched asymptomatic healthy adults were recruited as the controls. The sacral slope (SS), lumbar lordosis (LL), spino-sacral angle (SSA), C7 tilt (C7T), and sagittal vertical axis (SVA [C7]) were measured on lateral whole spine radiographs. The presence of low back pain and visual analogue scale (VAS) scores were recorded.ResultsThe patients with Crowe IV DDH showed significantly greater SS (47.5 ± 7.5° vs. 40.4 ± 6.7°, p < 0.05), LL (− 63.7 ± 9.2° vs. − 53.3 ± 11.5°, P < 0.05), SSA (141.8° ± 7.2° vs. 130.6 ± 7.9°, p < 0.05), C7T (93.9 ± 3.6° vs. 91.1 ± 3.7°, P < 0.05), and lower SVA(C7) (− 16 mm[− 95–45] vs. 6.4 mm[− 52–47], p < 0.05) compared to the controls. The patients with bilateral Crowe IV DDH also exhibited larger SS, LL, SSA, and C7T and a smaller SVA (C7) than those with unilateral Crowe IV DDH. Sixty-three percent of the patients with Crowe IV DDH reported low back pain.ConclusionThe patients with Crowe IV DDH exhibited abnormal spinal-pelvic alignment characterized by anterior pelvic tilt, lumbar hyperlordosis, and a backward-leaning trunk. Bilateral Crowe IV DDH had a greater impact on spinal-pelvic alignment than unilateral Crowe IV DDH.
Highlights
The impact of high dislocated dysplastic hips on spinal-pelvic alignment has not been well described
The exclusion criteria included the following: (1) a prior history of spinal surgery; (2) marked osteoarthritis in the knee or ankle; (3) lower limb radicular pain; (4) symptomatic spinal stenosis; (5) neurological disorders affecting postural control; (6) other diseases that would affect spinal-pelvic alignment, including lumbar disc herniation, spondylolisthesis, primary spinal deformity, severe lumbar spine degenerative change (Weiner Grade 3, which was performed by a senior surgeon reviewing the images and grading them according to the Weiner system.) [13], and a history of thoracolumbar fracture; and (7) patient preference by declining to participate in the study
In this study, we found that the patients with Crowe IV developmental dysplasia of the hip (DDH) showed significantly greater sacral slope (SS), lumbar lordosis (LL), spino-sacral angle (SSA), C7 tilt (C7T), and lower Sagittal vertical axis (SVA)(C7) than controls, which was more obvious in the patients with bilateral Crowe IV DDH
Summary
The impact of high dislocated dysplastic hips on spinal-pelvic alignment has not been well described. This study aims to evaluate compensatory spinal radiographic changes and presence of back pain in patients with Crowe type IV developmental dysplasia of the hip (DDH). Sagittal spinal-pelvic alignment, first described in 1998, has been well studied in patients with spinal disorders, including low back pain, spondylolisthesis, and spinal deformities [2,3,4,5]. The incidence of hip dysplastic dislocation was reported to be between 0.1–0.15% in newborns and often involved unilateral side [8]. High dislocated dysplastic hips are classified as Crowe IV developmental dysplasia of the hip (DDH), and may lead to hip pain, limp or wobbling gait [11]. Matsuyama reported changes in the sagittal alignment of the spine in patients with
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