title: Decreased Lumbar Lordosis and Deficient Acetabular Coverage Are Risk Factors for Subchondral Insufficiency Fracture.
abstract: Subchondral insufficiency fracture (SIF) of the femoral head occurs in the elderly and recipients of organ transplantation. Osteoporosis and deficient lateral coverage of the acetabulum are known risk factors for SIF. There has been no study about relation between spinopelvic alignment and anterior acetabular coverage with SIF. We therefore asked whether a decrease of lumbar lordosis and a deficiency in the anterior acetabular coverage are risk factors. We investigated 37 patients with SIF. There were 33 women and 4 men, and their mean age was 71.5 years (59-85 years). These 37 patients were matched with 37 controls for gender, age, height, weight, body mass index and bone mineral density. We compared the lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, acetabular index, acetabular roof angle, acetabular head index, anterior center-edge angle and lateral center-edge angle. Lumbar lordosis, pelvic tilt, sacral slope, lateral center edge angle, anterior center edge angle, acetabular index and acetabular head index were significantly different between SIF group and control group. Lumbar lordosis (OR = 1.11), lateral center edge angle (OR = 1.30) and anterior center edge angle (OR = 1.27) had significant associations in multivariate analysis. Decreased lumbar lordosis and deficient anterior coverage of the acetabulum are risk factors for SIF as well as decreased lateral coverage of the acetabulum.
authors.affiliation: Department of Orthopaedic Surgery, The Catholic University of Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: Woo Lam
authors.identifier: http://orcid.org/0000-0001-7021-9348
authors.initials: WL
authors.lastname: Jo
authors.affiliation: Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea. WSLEEOS@yuhs.ac.
authors.forename: Woo Suk
authors.identifier: http://orcid.org/0000-0002-0798-1660
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, International St. Mary's Hospital, Incheon, Korea.
authors.forename: Dong Sik
authors.identifier: http://orcid.org/0000-0002-7936-088X
authors.initials: DS
authors.lastname: Chae
authors.affiliation: Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ick Hwan
authors.identifier: http://orcid.org/0000-0002-5081-2598
authors.initials: IH
authors.lastname: Yang
authors.affiliation: Department of Orthopaedic Surgery, Seoul national University Bundang Hospital, Seongnam, Korea.
authors.forename: Kyoung Min
authors.identifier: http://orcid.org/0000-0002-3819-4002
authors.initials: KM
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Seoul national University Bundang Hospital, Seongnam, Korea.
authors.forename: Kyung Hoi
authors.identifier: http://orcid.org/0000-0001-5251-2911
authors.initials: KH
authors.lastname: Koo
mesh_terms: D015502:Absorptiometry, Photon; D000077:Acetabulum / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015519:Bone Density; D016022:Case-Control Studies; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging; D015775:Fractures, Stress / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors
keywords: Deficient Acetabular Coverage; Lumbar Lordosis; Subchondral Insufficiency Fracture