Evaluation of anatomical pelvic parameters between normal, healthy men and women using three-dimensional computed tomography: a cross-sectional study of sex-specific and age-specific differences

Abstract

Background: Sagittal spinal balance and standing posture are affected by pelvic morphology, especially pelvic incidence (PI). However, it is not difficult to identify the hip center because of overlap of the pelvis, image contrast, and soft tissue artifacts. Measurements of PI are not always suitable in all patients, especially those with osteoarthritis of the hip joint whose femoral head is nonspherical, subluxed, or dislocated. We measured PI, pelvic tilt (PT), and sacral slope (SS) as anatomical parameters using a novel three-dimensional measurement in order to compare the pelvic morphology between normal, healthy men and women.

Methods: In this cross-sectional study, we evaluated 108 Japanese subjects (55 men, 53 women) without low back or knee pain. We used the three-dimensional pelvis model adjusted to the anterior pelvic plane and measured the pelvic parameters. The subjects were stratified by age (< 50 versus ≥ 50 years) and sex. Intraobserver and interobserver reliabilities were calculated with intraclass correlation coefficients.

Results: There was no significant difference in PI, anatomical-PT, and anatomical-SS between sexes. There was a strong correlation between PI and anatomical-SS in men and women (R = 0.790 and 0.715, respectively). Values of anatomical-PT were lower, and values of anatomical-SS were greater among older subjects than among younger subjects; the value of PI was similar between younger and older subjects. Intraobserver and interobserver mean absolute differences were about 2 mm and 2°, respectively; the intraclass correlation coefficient was > 0.87.

Conclusions: We found a strong correlation between PI and anatomical-SS in men and women. This novel measurement concept may be useful to estimate PI from anatomical-SS because the measurements of PI are not always suitable in all patients, especially those with osteoarthritis of the hip joint whose femoral head is not spherical or whose femoral head is subluxed or dislocated. This is the first report to describe the relationship between PI, anatomical-PT, and anatomical-SS as morphologic parameters with a high interclass correlation coefficient for intraobserver and interobserver reliabilities.

Keywords: 3D bone model; Anatomical parameters; Measurement error; Pelvic incidence; Pelvic morphological parameters; Pelvic tilt; Sacral slope; Sagittal alignment; Sagittal spinal balance; Three-dimensional measurement.

Fig. 1

Definition of the center of the sacral end plate of S1. The center of the sacral end plate of S1 (c) is defined as the point that divided the right and left halves in the coronal plane (a) and divided the front and rear halves in the sagittal plane (b)

Fig. 2

Pelvic parameters in the sagittal plane. PI, PT (anatomical-PT), and SS (anatomical-SS) are considered as anatomical parameters because APP was corrected to 0° in this study (a). PI pelvic incidence, anatomical-PT anatomical pelvic tilt, anatomical-SS anatomical sacral slope, R-FC center of the femoral head on the right, L-FC center of the femoral head on the left (a), TD total distance between the center of the sacral end plate and hip axis, DY_p distance of the Y_p coordinate, DZ_p distance of the Z_p coordinate (b)