title: Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis: A radiographic study.
abstract: OBJECTIVE
  Normal sagittal spine-pelvis-lower extremity alignment is crucial in humans for maintaining an ergonomic upright standing posture, and pathogenesis in any segment leads to poor balance. The present study aimed to investigate how this sagittal alignment can be affected by severe knee osteoarthritis (KOA), and whether associated changes corresponded with symptoms of lower back pain (LBP) in this patient population.
  
  
  METHODS
  Lateral radiograph films in an upright standing position were obtained from 59 patients with severe KOA and 58 asymptomatic controls free from KOA. Sagittal alignment of the spine, pelvis, hip and proximal femur was quantified by measuring several radiographic parameters. Global balance was accessed according to the relative position of the C7 plumb line to the sacrum and femoral heads. The presence of chronic LBP was documented. Comparisons between the two groups were carried by independent samples t-tests or chi-squared test.
  
  
  RESULTS
  Patients with severe KOA showed significant backward femoral inclination (FI), hip flexion, forward spinal inclination, and higher prevalence of global imbalance (27.1% versus 3.4%, p < 0.001) compared with controls. In addition, patients with FI of 10° (n = 23) showed reduced lumbar lordosis and significant forward spinal inclination compared with controls, whereas those with FI > 10° (n = 36) presented with significant pelvic anteversion and hip flexion. A total of 39 patients with KOA (66.1%) suffered from LBP. There was no significant difference in sagittal alignment between KOA patients with and without LBP.
  
  
  CONCLUSIONS
  The sagittal alignment of spine-pelvis-lower extremity axis was significantly influenced by severe KOA. The lumbar spine served as the primary source of compensation, while hip flexion and pelvic anteversion increased for further compensation. Changes in sagittal alignment may not be involved in the pathogenesis of LBP in this patient population.Cite this article: W. J. Wang, F. Liu, Y.W. Zhu, M.H. Sun, Y. Qiu, W. J. Weng. Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis: A radiographic study. Bone Joint Res 2016;5:198-205. DOI:10.1302/2046-3758.55.2000538.
authors.affiliation: Nanjing University Medical School, Drum Tower Hospital, Nanjing 210008, China.
authors.forename: W J
authors.initials: WJ
authors.lastname: Wang
authors.affiliation: Nanjing University Medical School, Drum Tower Hospital, Nanjing 210008, China.
authors.forename: F
authors.initials: F
authors.lastname: Liu
authors.affiliation: Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Y W
authors.initials: YW
authors.lastname: Zhu
authors.affiliation: Nanjing University Medical School, Drum Tower Hospital, Nanjing 210008, China.
authors.forename: M H
authors.initials: MH
authors.lastname: Sun
authors.affiliation: Nanjing University Medical School, Drum Tower Hospital, Nanjing 210008, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: Nanjing University Medical School, Drum Tower Hospital, Nanjing 210008, China drwengwenjie@163.com.
authors.forename: W J
authors.initials: WJ
authors.lastname: Weng
keywords: Hip flexion; Knee osteoarthritis; Low back pain; Lumbar lordosis; Sagittal alignment