Changes in sagittal vertebral–pelvic ratios in children with a high position of the large trochanter after surgical treatment

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Abstract

BACKGROUND: Alteration in the anatomical shape and structure of the proximal femur is a common orthopedic problem in children. In most cases, this is accompanied by a high position of the large trochanter, which leads not only to the development of extraarticular impingement syndrome and the progression of coxarthrosis, but also to impaired vertebral–pelvic relations.

AIM: To evaluate the effect of the transposition of the large trochanter in children on changes in the radiological parameters of sagittal vertebral–pelvic ratios.

MATERIALS AND METHODS: The study included 20 patients (20 hip joints) aged 9–15 years with deformity of the proximal femur, which was accompanied by a high position of the large trochanter. The patients underwent clinical and X-ray examination before and after surgical treatment, i.e., transposition of the large trochanter according to original methods. The pelvic angle, lumbar lordosis, thoracic kyphosis, pelvic deviation angle, sacral tilt, and sagittal vertical axis (SVA) were evaluated. The obtained data were analyzed statistically.

RESULTS: Excessive pelvic anteversion and vertical posture of the hyperlordotic type are characteristics of the patients analyzed. These signs were manifested as a significant increase in global lumbar lordosis and the angle of inclination of the sacrum and a decrease in the angle of inclination of the pelvis, in combination with a negative imbalance in SVA. The surgery made it possible to normalize the articulotrochanteric distance index and increase the angle of inclination of the pelvis while reducing the sacral slope, which improved global lumbar lordosis.

CONCLUSIONS: After the surgical intervention, in addition to restoring normal ratios in the hip joint and eliminating the extraarticular femoroacetabular impingement syndrome, the hyperlordotic type of vertical posture transformed toward the normal one in accordance with the classification of R. Rousully, which resulted in the prevention of the development of degenerative and dystrophic changes in the lumbar spine.

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About the authors

Ivan Yu. Pozdnikin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: pozdnikin@gmail.com
ORCID iD: 0000-0002-7026-1586
SPIN-code: 3744-8613

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Pavel I. Bortulev

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817
SPIN-code: 9903-6861
Scopus Author ID: 57193258940

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Sergei V. Vissarionov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN-code: 7125-4930
Scopus Author ID: 6504128319
ResearcherId: P-8596-2015

MD, PhD, Dr. Sci. (Med.), Professor, Corresponding Member of RAS

Russian Federation, Saint Petersburg

Dmitriy B. Barsukov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634
SPIN-code: 2454-6548

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Tamila V. Baskaeva

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: tamila-baskaeva@mail.ru
ORCID iD: 0000-0001-9865-2434
SPIN-code: 5487-4230

MD, orthopedic and trauma surgeon

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Scheme for calculating the relationship between the femoral head and the greater trochanter in the frontal plane (ATD indicator) (according to McCarthy J.J., Weiner D.S., 2008, as amended). In this case, the indicator takes negative values since the apex of the greater trochanter is located above the upper pole of the head [15]

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3. Fig. 2. An example of calculating pelvivertebral relationships on a lateral panoramic radiograph of the spine, including the hip joints, in a patient after surgical treatment. The explanations are presented in the text

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4. Fig. 3. Scheme of the reconstructed hip joint and transposition of the greater trochanter according to RF patent No. 2734054: (a) hip joint (front view); (b) proximal femur (posterior view); (c) proximal femur (top view); (d) proximal femur after surgery (front view). (1) femoral head; (2) greater trochanter; (3) lesser trochanter; (4) osteotomy line of the greater trochanter; (5) line of modeling resection of the neck, base of the greater and resection of the lesser trochanter, posterior view; (6) line of modeling resection of the neck and base of the greater trochanter, front view; (7) cortical screws fixing the greater trochanter

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5. Fig. 4. Correlations based on the main indicators of sagittal pelvivertebral relationships and X-ray anatomical position of the greater trochanter in patients after surgical treatment. Explanations are presented in the text

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6. Fig. 5. Results of regression analysis between indicators of sagittal balance and X-ray anatomical position of the greater trochanter: (a) between PI and SS; (b) between GLL and SS; (c) between PI and ATD; (d) between SS and ATD. PI, pelvic incidence; SS, sacral slope; GLL, global lumbar lordosis; ATD, articulo-trochanteric distance

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