The Impact of Pelvic Incidence on Spinopelvic and Hip Alignment and Mobility in Asymptomatic Subjects

Abstract

Background: The influence of pelvic incidence (PI) on spinopelvic and hip alignment and mobility has not been well investigated. The aim of this study was to evaluate the influence of PI on spinopelvic and hip alignment and mobility, including the pelvic-femoral angle (PFA) and motion (ΔPFA), in functional positions in a cohort of asymptomatic volunteers.

Methods:

This was a single-center, prospective, cross-sectional study. We included 136 healthy volunteers (69% female; mean age, 38 ± 11 years; mean body mass index, 22 ± 3 kg/m2) divided into 3 subgroups on the basis of their PI: PI < 45° (low PI), 45° ≤ PI ≤ 60° (medium PI), and PI > 60° (high PI). We made full-body lateral radiographs in free-standing, standing with extension, relaxed-seated, and flexed-seated positions. We measured the sacral slope (SS), lumbar lordosis (LL), and PFA. We calculated lumbar (∆LL), pelvic (∆SS), and hip (∆PFA) mobilities as the change between the standing (i.e., standing with or without extension) and sitting (i.e., relaxed-seated or flexed-seated) positions.

Results:

There were significant differences between some of the 3 subgroups with respect to the LL, SS, and PFA in each of the 4 positions. There were no significant differences in ΔLL, ΔSS, or ΔPFA between the 3 groups when moving from a standing to a sitting position. PI had an inverse linear correlation with PFAextension (R = −0.48; p < 0.0001), PFAstanding (R = −0.53; p < 0.0001), PFArelaxed-seated (R = −0.37; p < 0.0001), and PFAflexed-seated (R = −0.47; p < 0.0001). However, PI was not correlated with ΔPFAstanding/relaxed-seated (R = −0.062; p = 0.48) or ΔPFAextension/flexed-seated (R = −0.12; p = 0.18). Similarly, PI was not significantly correlated with ΔLL or ΔSS in either pair of positions.

Conclusions:

This study confirmed that spinopelvic and hip parameters in functional positions were affected by PI, whereas lumbar, pelvic, and hip mobilities did not depend on PI. These findings suggest that hip surgeons should consider the PI of the patient to determine the patient’s specific functional safe zones before and after total hip arthroplasty.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.