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

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.

Keywords

“hypertrophy” of the large trochanter / sagittal spine profile / deformities of the proximal femur / vertebral–pelvic complex / hip joint

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Funding

Министерство здравоохранения Российской ФедерацииMinistry of Health of the Russian Federation(121031700122-6)

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