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S2 alar-iliac screw loosening as a preventive factor for hip joint osteoarthritis after adult spinal deformity surgery: a case–control study

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Abstract

Purpose

This study aimed to evaluate the progression of hip pathology and risk factors after ASD surgery.

Methods

This case–control study enrolled 123 patients (246 hips); seven hips underwent hip arthroplasty were excluded. We measured the center-edge (CE) angle, joint space width (JSW), and Kellgren–Lawrence (KL) grade. We defined a CE angle˂25° as developmental dysplasia of the hip (DDH). We evaluated S2 alar-iliac (AI) screw loosening at final follow-up.

Results

The annual decrease in the JSW was 0.31 mm up to 1 year, and 0.13 mm after 1 year (p = 0.001). KL grade progression occurred in 24 hips (10.0%; group P), while no progression occurred in 215 (90.0%; group N) hips. Nonparametric analysis between groups P and N revealed that significant differences were observed in sex, DDH, KL grade, ratio of S2AI screw fixation at baseline, and ratio of S2AI screw loosening at final follow-up. Multiple logistic regression analysis revealed that DDH (p = 0.018, odds ratio (OR) = 3.0, 95%CI = 1.2–7.3), baseline KL grade (p < 0.0001, OR = 37.7, 95%CI = 7.0–203.2), and S2AI screw fixation (p = 0.035, OR = 3.4, 95%CI = 1.1–10.4) were significant factors. We performed sub-analysis to elucidate the relationship between screw loosening and hip osteoarthritis in 131 hips that underwent S2AI screw fixation. Non-loosening of the S2AI screw was a significant factor for KL grade progression (p < 0.0001, OR = 8.9, 95%CI = 3.0–26.4).

Conclusion

This study identified the prevalence and risk factors for the progression of hip osteoarthritis after ASD surgery. Physicians need to pay attention to the hip joint pathology after ASD surgery.

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Availability of data and materials

The datasets during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Code availability

The datasets during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Hashimoto K, Aizawa T, Kanno H, Itoi E (2019) Adjacent segment degeneration after fusion spinal surgery-a systematic review. Int Orthop 43:987–993. https://doi.org/10.1007/s00264-018-4241-z

    Article  PubMed  Google Scholar 

  2. Yagi M, King AB, Boachie-Adjei O (2012) Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years of follow-up. Spine (Phila Pa 1976) 37:1479–1489. https://doi.org/10.1097/BRS.0b013e31824e4888

    Article  Google Scholar 

  3. Mekhael M, Kawkabani G, Saliby RM, Skalli W, Saad E, Jaber E, Rachkidi R, Kharrat K, Kreichati G, Ghanem I, Lafage V, Assi A (2021) Toward understanding the underlying mechanisms of pelvic tilt reserve in adult spinal deformity: the role of the 3D hip orientation. Eur Spine J 30:2495–2503. https://doi.org/10.1007/s00586-021-06778-4

    Article  PubMed  Google Scholar 

  4. Kozaki T, Hashizume H, Nishiyama D, Iwasaki H, Tsutsui S, Takami M, Yukawa Y, Minamide A, Taniguchi T, Nagata K, Fukui D, Tamai H, Taiji R, Murata S, Oka H, Yamada H (2021) Adjacent segment disease on hip joint as a complication of spinal fusion surgery including sacroiliac joint fixation. Eur Spine J 30:1314–1319. https://doi.org/10.1007/s00586-020-06700-4

    Article  PubMed  Google Scholar 

  5. Iijima Y, Kotani T, Sakuma T, Nakayama K, Akazawa T, Kishida S, Muramatsu Y, Sasaki Y, Ueno K, Asada T, Sato K, Minami S, Ohtori S (2020) Risk factors for loosening of S2 alar iliac screw: surgical outcomes of adult spinal deformity. Asian Spine J 14:864–871. https://doi.org/10.31616/asj.2020.0100

    Article  PubMed  PubMed Central  Google Scholar 

  6. Nakashima H, Kanemura T, Satake K, Ito K, Ishikawa Y, Ouchida J, Segi N, Yamaguchi H, Imagama S (2020) The prevalence and risk factors for S2 alar-iliac screw loosening with a minimum 2-year follow-up. Asian Spine J 14:177–184. https://doi.org/10.31616/asj.2019.0127

    Article  PubMed  Google Scholar 

  7. Hasegawa K, Okamoto M, Hatsushikano S, Caseiro G, Watanabe K (2018) Difference in whole spinal alignment between supine and standing positions in patients with adult spinal deformity using a new comparison method with slot-scanning three-dimensional X-ray imager and computed tomography through digital reconstructed radiography. BMC Musculoskelet Disord 19:437. https://doi.org/10.1186/s12891-018-2355-5

    Article  PubMed  PubMed Central  Google Scholar 

  8. Monazzam S, Williams KA, Shelton TJ, Calafi A, Haus BM (2018) Anterior centre-edge angle on sagittal CT: a comparison of normal hips to dysplastic hips. Hip Int 28:535–541. https://doi.org/10.1177/1120700017752569

    Article  PubMed  Google Scholar 

  9. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502. https://doi.org/10.1136/ard.16.4.494

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Reijiman M, Hazes JMW, Pols HAP, Koes BW, Bierma-Zeinstra MA (2005) Acetabular dysplasia predicts incident osteoarthritis of the hip. The Rotterdam Study Arthritis Rheum 52(3):787–793. https://doi.org/10.1002/art.20886

    Article  Google Scholar 

  11. Tateuchi H, Koyama Y, Akiyama H, Goto K, So K, Kuroda Y, Ichihashi N (2017) Daily cumulative hip moment is associated with radiographic progression of secondary hip osteoarthritis. Osteoarthr Cartil 25:1291–1298. https://doi.org/10.1016/j.joca.2017.02.796

    Article  CAS  Google Scholar 

  12. Ilyas H, Place H, Puryear A (2015) A comparison of early clinical and radiographic complications of iliac screw fixation versus S2 alar iliac (S2AI) fixation in the adult and pediatric populations. J Spinal Disord Tech 28:E199-205. https://doi.org/10.1097/BSD.0000000000000222

    Article  PubMed  Google Scholar 

  13. De la Garza RR, Nakhla J, Sciubba DM, Yassari R (2018) Iliac screw versus S2 alar-iliac screw fixation in adults: a meta-analysis. J Neurosurg Spine 30:253–258. https://doi.org/10.3171/2018.7.SPINE18710

    Article  Google Scholar 

  14. Denis F, Sun EC, Winter RB (2009) Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up. Spine (Phila Pa 1976) 34:E729–E734. https://doi.org/10.1097/BRS.0b013e3181ae2ab2

    Article  Google Scholar 

  15. Untch C, Liu Q, Hart R (2004) Segmental motion adjacent to an instrumented lumbar fusion: the effect of extension of fusion to the sacrum. Spine (Phila Pa 1976) 29:2376–2381. https://doi.org/10.1097/01.brs.0000143667.55696.bd

    Article  Google Scholar 

  16. Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH (2012) The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 221:537–567. https://doi.org/10.1111/j.1469-7580.2012.01564.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Tateuchi H, Akiyama H, Goto K, So K, Kuroda Y, Ichihashi N (2018) Sagittal alignment and mobility of the thoracolumbar spine are associated with radiographic progression of secondary hip osteoarthritis. Osteoarthr Cartil 26:397–404. https://doi.org/10.1016/j.joca.2017.12.005

    Article  CAS  Google Scholar 

  18. Esposito CI, Miller TT, Kim HJ, Barlow BT, Wright TM, Padgett DE, Jerabek SA, Mayman DJ (2016) Does degenerative lumbar spine disease influence femoroacetabular flexion in patients undergoing total hip arthroplasty? Clin Orthop Relat Res 474:1788–1797. https://doi.org/10.1007/s11999-016-4787-2

    Article  PubMed  PubMed Central  Google Scholar 

  19. Prieto-Alhambra D, Judge A, Javaid MK, Cooper C, Diez-Perez A, Arden NK (2014) Incidence and risk factors for clinically diagnosed knee, hip and hand osteoarthritis: influences of age, gender and osteoarthritis affecting other joints. Ann Rheum Dis 73:1659–1664. https://doi.org/10.1136/annrheumdis-2013-203355

    Article  PubMed  Google Scholar 

  20. Oliveria SA, Felson DT, Reed JI, Cirillo PA, Walker AM (1995) Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis Rheum 38:1134–1141. https://doi.org/10.1002/art.1780380817

    Article  CAS  PubMed  Google Scholar 

  21. Iidaka T, Muraki S, Oka H, Horii C, Kawaguchi H, Nakamura K, Akune T, Tanaka S, Yoshimura N (2020) Incidence rate and risk factors for radiographic hip osteoarthritis in Japanese men and women: a 10-year follow-up of the ROAD study. Osteoarthr Cartil 28:182–188. https://doi.org/10.1016/j.joca.2019.09.006

    Article  CAS  Google Scholar 

  22. Jingushi S, Ohfuji S, Sofue M, Hirota Y, Itoman M, Matsumoto T, Hamada Y, Shindo H, Takatori Y, Yamada H, Yasunaga Y, Ito H, Mori S, Owan I, Fujii G, Ohashi H, Iwamoto Y, Miyanishi K, Iga T, Takahira N, Sugimori T, Sugiyama H, Okano K, Karita T, Ando K, Hamaki T, Hirayama T, Iwata K, Nakasone S, Matsuura M, Mawatari T (2010) Multiinstitutional epidemiological study regarding osteoarthritis of the hip in Japan. J Orthop Sci 15:626–631. https://doi.org/10.1007/s00776-010-1507-8

    Article  PubMed  Google Scholar 

  23. Teirlinck CH, Dorleijn DMJ, Bos PK, Rijkels-Otters JBM, Bierma-Zeinstra SMA, Luijsterburg PAJ (2019) Prognostic factors for progression of osteoarthritis of the hip: a systematic review. Arthritis Res Ther 21:192. https://doi.org/10.1186/s13075-019-1969-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Yoshimura N, Sasaki S, Iwasaki K, Danjoh S, Kinoshita H, Yasuda T, Tamaki T, Hashimoto T, Kellingray S, Croft P, Coggon D, Cooper C (2000) Occupational lifting is associated with hip osteoarthritis: a Japanese case-control study. J Rheumatol 27:434–440

    CAS  PubMed  Google Scholar 

  25. Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87:1012–1018. https://doi.org/10.1302/0301-620X.87B7.15203

    Article  CAS  PubMed  Google Scholar 

  26. Shapira J, Chen JW, Bheem R, Lall AC, Rosinsky PJ, Maldonado DR, Domb BG (2020) Radiographic factors associated with hip osteoarthritis: a systematic review. J Hip Preserv Surg 7:4–13. https://doi.org/10.1093/jhps/hnz073

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan

    Takuhei Kozaki, Hiroshi Hashizume, Takaya Taniguchi, Daisuke Nishiyama, Hiroshi Iwasaki, Shunji Tsutsui, Masanari Takami, Keiji Nagata, Daisuke Fukui, Manabu Yamanaka, Hidenobu Tamai, Ryo Taiji, Shizumasa Murata & Hiroshi Yamada

  2. School of Health and Nursing Science, Wakayama Medical University, 580 Mikazura, Wakayama City, Japan

    Hiroshi Hashizume

  3. Department of Medical Research and Management for Musculoskeletal Pain, 22Nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan

    Hiroyuki Oka

Authors
  1. Takuhei Kozaki
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  2. Hiroshi Hashizume
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  15. Hiroshi Yamada
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Contributions

TK and HH designed and performed the experiments, derived the models, and analyzed the data. IH, ST, and MT performed the surgical procedures. YY, AM, HO, and HY encouraged TK to investigate and supervise the findings of this study. KN, RT, and SM assisted with the measurements. TK wrote the manuscript in consultation with all authors.

Corresponding author

Correspondence to Hiroshi Hashizume.

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The authors have no conflicts of interest to declare.

Ethical approval

All patients provided informed consent prior to surgery, and the study protocol was approved by the institutional ethics committee of Wakayama Medical University.

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All patients provided informed consent prior to surgery.

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All patients provided informed consent for publication.

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Kozaki, T., Hashizume, H., Taniguchi, T. et al. S2 alar-iliac screw loosening as a preventive factor for hip joint osteoarthritis after adult spinal deformity surgery: a case–control study. Eur Spine J 31, 3081–3088 (2022). https://doi.org/10.1007/s00586-022-07344-2

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  • DOI: https://doi.org/10.1007/s00586-022-07344-2

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