European Spine Journal

, Volume 27, Issue 2, pp 475–481 | Cite as

Sagittal spino-pelvic alignment in rapidly destructive coxarthrosis

  • Tadatsugu Morimoto
  • Masaru Kitajima
  • Masatsugu Tsukamoto
  • Tomohito Yoshihara
  • Motoki Sonohata
  • Masaaki Mawatari
Original Article



To investigate the sagittal spino-pelvic alignment (SSPA) in patients with rapidly destructive coxarthrosis (RDC).


SSPA was investigated in 44 patients with RDC and 70 patients with hip osteoarthritis (HOA). The study included only female patients over the age of 70 years because epidemiological reports indicate that RDC most commonly occurs in this group of patients. The SSPA parameters that were analyzed included lumbar lordosis (LL), lumbar range of motion (ΔLL), sacral slope (SS), pelvic incidence (PI), and pelvic tilt (PT). The pelvic inclination angle (PIA) in the supine position and the change in the PIA from the supine to the standing position (ΔPIA) were measured using anteroposterior pelvic radiographs. The values of these parameters were compared between the two groups. The levels of the SRS-Schwab classification modifiers were used to investigate the degree of sagittal malalignment.


The RDC group showed significant lower LL, ΔLL and SS values, and significantly higher PT and ΔPIA values than the HOA group (P < 0.01). With regard to the sagittal modifiers in the SRS-Schwab classifications of the patients, the PI-LL and PT levels of the RDC group were significantly worse than those in the HOA group (P < 0.01).


The present study suggests that the static factors of a reduction in the lumbar lordotic angle and greater posterior pelvic tilt, the dynamic factors of small ΔLL values and large ΔPIA values and the complex interaction of these two types of factors, may play important roles in the development of RDC.


Sagittal spino-pelvic alignment Rapidly destructive coxarthrosis Pelvic tilt Hip-spine syndrome 


Compliance with ethical standards

Conflict of interest

There is no conflict of interest with any financial organization regarding the material discussed in this manuscript.


  1. 1.
    Flik K, Vargas JH (2000) Rapidly destructive hip disease: a case report and review of the literature. Am J Orthop 29:549–552PubMedGoogle Scholar
  2. 2.
    Postel M, Kerboull M (1970) Total prosthetic replacement in rapidly destructive arthrosis of the hip joint. Clin Orthop Relat Res 72:138–144PubMedGoogle Scholar
  3. 3.
    Ogawa K, Mawatari M, Kimine M, Shigematsu M, Kitajima M, Kukita A, Hotokebuchi T (2007) Mature and activated osteoclasts exist in the synovium of rapidly destructive coxarthrosis. J Bone Miner Metab 25:354–360CrossRefPubMedGoogle Scholar
  4. 4.
    Menkes CJ, Simon F, Delrieu F, Forest M, Delbarre (1976) Destructive arthropathy in chondrocalcinosis articularis. Arthritis Rheumatol 19:329–348CrossRefGoogle Scholar
  5. 5.
    Slowman-Kovacs SD, Braunstein EM, Brandt KD (1990) Rapidly progressive Charcot arthropathy following minor joint trauma in patients with diabetic neuropathy. Arthritis Rheumatol 33:412–417CrossRefGoogle Scholar
  6. 6.
    Yamamoto T, Bullough PG (2000) The role of subchondral insufficiency fracture in rapid destruction of the hip joint: a preliminary study. Arthritis Rheumatol 43:2423–2427CrossRefGoogle Scholar
  7. 7.
    Offierski CM, MacNab I (1983) Hip-spine syndrome. Spine 8:316–321CrossRefPubMedGoogle Scholar
  8. 8.
    Homma Y, Baba T, Sumiyoshi N, Ochi H, Kobayashi H, Matsumoto M, Yuasa T, Kaneko K (2014) Rapid hip osteoarthritis development in a patient with anterior acetabular cyst with sagittal alignment change. Case Rep Orthop 2014:523426. doi: 10.1155/2014/523426 PubMedPubMedCentralGoogle Scholar
  9. 9.
    TakemitsuY Harada Y, Miyamoto M, Miyatake Y (1988) Lumbar degenerative kyphosis. Spine 13:1317–1326CrossRefGoogle Scholar
  10. 10.
    Yoshimoto H, Sato S, Kanno T, Shundo M, Hyakumachi T, Yanagibashi Y (2005) Spinopelvic alignment in patients with osteoarthritis of the hip: a radiographic comparison to patients with low back pain. Spine 30:1650–1657CrossRefPubMedGoogle Scholar
  11. 11.
    Watanabe W, Sato K, Itoi E, Yang K (2002) Watanabe H (2002) Posterior pelvic tilt in patients with decreased lumbar lordosis decreases acetabular femoral head covering. Orthopedics 25:321–324PubMedGoogle Scholar
  12. 12.
    Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine 25:575–586CrossRefPubMedGoogle Scholar
  13. 13.
    Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11:80–87CrossRefPubMedGoogle Scholar
  14. 14.
    Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, Mehdian H, Shaffrey C, Tribus C, Lafage V (2012) Scoliosis research society—Schwab adult deformity classification: a validation study. Spine 37:1077–1082CrossRefPubMedGoogle Scholar
  15. 15.
    Kitajima M, Mawatari M, Aita K, Shigematu M, Ogawa K, Hotokebuchi T (2006) A simple method to determine the pelvic inclination angle based on anteroposterior radiographs. J Orthop Sci 11:342–346CrossRefPubMedGoogle Scholar
  16. 16.
    Weir JP (2005) Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res 19:231–240PubMedGoogle Scholar
  17. 17.
    Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis–spine complex and lumbar degenerative diseases: a comparative study about 85 cases. Eur Spine J 16:1459–1467CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Burger H, Van Daele PLA, Grashuis K, Hofman A, Grobbee DE, Schutte HE, Birkenhager JC, Pols HA (1997) Vertebral deformities and functional impairment in men and women. J Bone Miner Res 12:152–157CrossRefPubMedGoogle Scholar
  19. 19.
    Hammerberg EM, Wood KB (2003) Sagittal profile of the elderly. J Spinal Disord Tech 16:44–50CrossRefPubMedGoogle Scholar
  20. 20.
    Jackson RP, Phipps T, Hales C, Surber J (2003) Pelvic lordosis and alignment in spondylolisthesis. Spine 2003(28):151–160CrossRefGoogle Scholar
  21. 21.
    Garbossa D, Pejrona M, Damilano M, Sansone V, Ducati A, Berjano P (2014) Pelvic parameters and global spine balance for spine degenerative disease: the importance of containing for the well being of content. Eur Spine J 23(Suppl 6):616–627. doi: 10.1007/s00586-014-3558-6 CrossRefPubMedGoogle Scholar
  22. 22.
    Okuda T, Fujita T, Miaki K, Yasuda Y, Matsumoto T (2007) Stage-specific sagittal alignment changes in osteoarthritis of the hip secondary to developmental hip dysplasia. Spine 32:E816–E819CrossRefPubMedGoogle Scholar
  23. 23.
    Endo K, Suzuki H, Nishimura H, Tanaka H, Shirado T, Yamamoto K (2014) Characteristics of sagittal spino-pelvic alignment in japanese young adults. Asian Spine J 8:599–604CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kanemura T, Yoshida G, Ishikawa Y et al (2011) Sagittal spino-pelvic alignment in an asymptomatic Japanese population—comparison of Western population. J Spine Res 2:52–58 (in Japanese) Google Scholar
  25. 25.
    Kim YC, Lenke LG, Lee SJ et al (2016) The cranial sagittal vertical axis (CrSVA) is a better radiographic measure to predict clinical outcomes in adult spinal deformity surgery than the C7 SVA: a monocentric study. Eur Spine J 26(8):2167–2175. doi: 10.1007/s00586-016-4757-0 CrossRefPubMedGoogle Scholar
  26. 26.
    Wang WJ, Liu F, Zhu YW, Sun MH et al (2016) Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis: a radiographic study. Bone Jt Res. 5:198–205. doi: 10.1302/2046-3758.55.2000538 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan

Personalised recommendations