Abstract：
BACKGROUND: Hip osteoarthritis (OA) is common in patients with adult spinal deformity (ASD). Limited data exist on the prevalence of hip OA in patients with ASD, or on its impact on baseline and postoperative alignment and patient-reported outcome measures (PROMs). Therefore, this paper will assess the prevalence and impact of hip OA on alignment and PROMs.
METHODS: Patients with ASD who underwent L1-pelvis or longer fusions were included. Two independent reviewers graded hip OA with the Kellgren-Lawrence (KL) classification and stratified it by severity into non-severe (KL grade 1 or 2) and severe (KL grade 3 or 4). Radiographic parameters and PROMs were compared among 3 patient groups: Hip-Spine (hip KL grade 3 or 4 bilaterally), Unilateral (UL)-Hip (hip KL grade 3 or 4 unilaterally), or Spine (hip KL grade 1 or 2 bilaterally).
RESULTS: Of 520 patients with ASD who met inclusion criteria for an OA prevalence analysis, 34% (177 of 520) had severe bilateral hip OA and unilateral or bilateral hip arthroplasty had been performed in 8.7% (45 of 520). A subset of 165 patients had all data components and were examined: 68 Hip-Spine, 32 UL-Hip, and 65 Spine. Hip-Spine patients were older (67.9 ± 9.5 years, versus 59.6 ± 10.1 years for Spine and 65.8 ± 7.5 years for UL-Hip; p < 0.001) and had a higher frailty index (4.3 ± 2.6, versus 2.7 ± 2.0 for UL-Hip and 2.9 ± 2.0 for Spine; p < 0.001). At 1 year, the groups had similar lumbar lordosis, yet the Hip-Spine patients had a worse sagittal vertebral axis (SVA) measurement (45.9 ± 45.5 mm, versus 25.1 ± 37.1 mm for UL-Hip and 19.0 ± 39.3 mm for Spine; p = 0.001). Hip-Spine patients also had worse Veterans RAND-12 Physical Component Summary scores at baseline (25.7 ± 9.3, versus 28.7 ± 9.8 for UL-Hip and 31.3 ± 10.5 for Spine; p = 0.005) and 1 year postoperatively (34.5 ± 11.4, versus 40.3 ± 10.4 for UL-Hip and 40.1 ± 10.9 for Spine; p = 0.006).
CONCLUSIONS: This study of operatively treated ASD revealed that 1 in 3 patients had severe hip OA bilaterally. Such patients with severe bilateral hip OA had worse baseline SVA and PROMs that persisted 1 year following ASD surgery, despite correction of lordosis.
METHODS: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
METHODS: Patients with ASD who underwent L1-pelvis or longer fusions were included. Two independent reviewers graded hip OA with the Kellgren-Lawrence (KL) classification and stratified it by severity into non-severe (KL grade 1 or 2) and severe (KL grade 3 or 4). Radiographic parameters and PROMs were compared among 3 patient groups: Hip-Spine (hip KL grade 3 or 4 bilaterally), Unilateral (UL)-Hip (hip KL grade 3 or 4 unilaterally), or Spine (hip KL grade 1 or 2 bilaterally).
RESULTS: Of 520 patients with ASD who met inclusion criteria for an OA prevalence analysis, 34% (177 of 520) had severe bilateral hip OA and unilateral or bilateral hip arthroplasty had been performed in 8.7% (45 of 520). A subset of 165 patients had all data components and were examined: 68 Hip-Spine, 32 UL-Hip, and 65 Spine. Hip-Spine patients were older (67.9 ± 9.5 years, versus 59.6 ± 10.1 years for Spine and 65.8 ± 7.5 years for UL-Hip; p < 0.001) and had a higher frailty index (4.3 ± 2.6, versus 2.7 ± 2.0 for UL-Hip and 2.9 ± 2.0 for Spine; p < 0.001). At 1 year, the groups had similar lumbar lordosis, yet the Hip-Spine patients had a worse sagittal vertebral axis (SVA) measurement (45.9 ± 45.5 mm, versus 25.1 ± 37.1 mm for UL-Hip and 19.0 ± 39.3 mm for Spine; p = 0.001). Hip-Spine patients also had worse Veterans RAND-12 Physical Component Summary scores at baseline (25.7 ± 9.3, versus 28.7 ± 9.8 for UL-Hip and 31.3 ± 10.5 for Spine; p = 0.005) and 1 year postoperatively (34.5 ± 11.4, versus 40.3 ± 10.4 for UL-Hip and 40.1 ± 10.9 for Spine; p = 0.006).
CONCLUSIONS: This study of operatively treated ASD revealed that 1 in 3 patients had severe hip OA bilaterally. Such patients with severe bilateral hip OA had worse baseline SVA and PROMs that persisted 1 year following ASD surgery, despite correction of lordosis.
METHODS: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
摘要：
背景：髋关节骨关节炎（OA）在成人脊柱畸形（ASD）患者中很常见。关于ASD患者髋关节OA患病率的数据有限，或其对基线和术后对齐和患者报告结局指标（PROMs）的影响。因此,本文将评估髋关节OA的患病率和对排列和PROM的影响。
方法：纳入接受L1-骨盆或更长融合的ASD患者。两名独立的审阅者将髋关节OA与Kellgren-Lawrence（KL）分类进行分级，并按严重程度将其分为非严重（KL等级1或2）和严重（KL等级3或4）。在3个患者组中比较了放射学参数和PROM：髋关节（双侧3或4级髋关节），单侧（UL）-髋部（单侧髋部KL3或4级），或脊柱（双侧髋关节KL1或2级）。
结果：520名符合OA患病率分析纳入标准的ASD患者中，34％（520中的177例）患有严重的双侧髋关节OA，并且在8.7％（520中的45例）中进行了单侧或双侧髋关节置换术。165例患者的子集具有所有数据成分，并接受了检查：68例髋关节，32UL-Hip,65脊柱髋关节患者年龄较大（67.9±9.5岁，脊柱为59.6±10.1年，UL-Hip为65.8±7.5年；p<0.001），并且具有更高的虚弱指数（UL-Hip为4.3±2.6，而脊柱为2.9±2.0；p<0.001）。在1年,两组有相似的腰椎前凸,然而，髋关节患者的矢状椎体轴（SVA）测量较差（45.9±45.5mm，UL-Hip为25.1±37.1mm，脊柱为19.0±39.3mm；p=0.001）。髋关节患者在基线时的退伍军人RAND-12身体成分汇总评分也较差（UL-Hip为25.7±9.3，与28.7±9.8相比，脊柱为31.3±10.5；p=0.005）和术后1年（UL-Hip为34.5±11.4，与40.3±10.4相比，脊柱为40.1±10.9；p=0.006）。
结论：这项手术治疗的ASD研究显示，1/3的患者双侧有严重的髋关节OA。这些患有严重双侧髋关节OA的患者在ASD手术后持续1年的基线SVA和PROM较差。尽管矫正了脊柱前凸.
方法：预后III级。有关证据级别的完整描述，请参阅作者说明。
方法：纳入接受L1-骨盆或更长融合的ASD患者。两名独立的审阅者将髋关节OA与Kellgren-Lawrence（KL）分类进行分级，并按严重程度将其分为非严重（KL等级1或2）和严重（KL等级3或4）。在3个患者组中比较了放射学参数和PROM：髋关节（双侧3或4级髋关节），单侧（UL）-髋部（单侧髋部KL3或4级），或脊柱（双侧髋关节KL1或2级）。
结果：520名符合OA患病率分析纳入标准的ASD患者中，34％（520中的177例）患有严重的双侧髋关节OA，并且在8.7％（520中的45例）中进行了单侧或双侧髋关节置换术。165例患者的子集具有所有数据成分，并接受了检查：68例髋关节，32UL-Hip,65脊柱髋关节患者年龄较大（67.9±9.5岁，脊柱为59.6±10.1年，UL-Hip为65.8±7.5年；p<0.001），并且具有更高的虚弱指数（UL-Hip为4.3±2.6，而脊柱为2.9±2.0；p<0.001）。在1年,两组有相似的腰椎前凸,然而，髋关节患者的矢状椎体轴（SVA）测量较差（45.9±45.5mm，UL-Hip为25.1±37.1mm，脊柱为19.0±39.3mm；p=0.001）。髋关节患者在基线时的退伍军人RAND-12身体成分汇总评分也较差（UL-Hip为25.7±9.3，与28.7±9.8相比，脊柱为31.3±10.5；p=0.005）和术后1年（UL-Hip为34.5±11.4，与40.3±10.4相比，脊柱为40.1±10.9；p=0.006）。
结论：这项手术治疗的ASD研究显示，1/3的患者双侧有严重的髋关节OA。这些患有严重双侧髋关节OA的患者在ASD手术后持续1年的基线SVA和PROM较差。尽管矫正了脊柱前凸.
方法：预后III级。有关证据级别的完整描述，请参阅作者说明。
