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. 2022 Aug 31;11(17):5153.
doi: 10.3390/jcm11175153.

Lumbosacral Transitional Vertebrae Influence on Acetabular Orientation and Pelvic Tilt

Luis Becker  1   2 , Nima Taheri  1 , Henryk Haffer  1 , Maximilian Muellner  1 , Christian Hipfl  1 , Katharina Ziegeler  3 , Torsten Diekhoff  3 , Matthias Pumberger  1
Affiliations

Lumbosacral Transitional Vertebrae Influence on Acetabular Orientation and Pelvic Tilt

Luis Becker et al. J Clin Med. .

Abstract

Lumbosacral transitional vertebrae (LSTV) are common congenital variances with a prevalence found in the population up to 35.6%. The literature demonstrates an influence of LSTV on bony pelvic anatomy. The influence on the anatomical acetabular orientation, which is important for cup positioning in total hip arthroplasty, has not yet been described for patients with LSTV. A total of 53 patients with LSTV were identified from a CT Database including 819 subjects. Fifty patients with LSTV could be included and were matched for age and sex against a control group. We examined the influence of LSTV, classified according to Castellvi, on acetabular orientation and pelvic tilt in the supine position. Functional acetabular anteversion and inclination, assessed against the table plane, were compared against anatomical acetabular anteversion and inclination, assessed against the anterior pelvic plane. The anatomical acetabular inclination correlated with the pelvic tilt (r = 0.363, p < 0.001). The anatomical acetabular inclination was significantly larger than the functional acetabular inclination in the supine position (p < 0.001). Castellvi grading of LSTV correlated negatively with pelvic tilt (ρ = −0.387, p = 0.006). Castellvi grading correlated significantly with functional acetabular anteversion (ρ = 0.324, p = 0.022) and anatomical acetabular anteversion (ρ = 0.306, p = 0.022). A higher Castellvi grading was accompanied by a reduced pelvic tilt in the supine position. The functional acetabular anteversion and anatomical acetabular anteversion increased in parallel to the higher Castellvi grading. Therefore, LSTV and Castellvi grading might be assessed on pre-operative X-rays prior to hip arthroplasty and surgeons might consider adjusting cup positioning accordingly.

Keywords: LSTV; acetabular anteversion; acetabular inclination; acetabular version; hip arthroplasty.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The measurement of the pelvic tilt in relation to the APP (anterior pelvic plane) is depicted.
Figure 2
Figure 2
Acetabular entry plane: (a) Visualizes the acetabular entry plane with the bony irregularities of the crista acetabuli slightly laterally displaced for better illustration. The acetabular entry plane defines the acetabular orientation and reproduces the crista acetabuli as accurately as possible. (b) Shows the crista acetabuli in relation to the acetabular entry plane, which has been moved toward the acetabular fossa for better visualization.
Figure 3
Figure 3
Measurement of the functional and anatomical acetabular orientation: (a) Shows the measurement of acetabular anteversion. (b) Demonstrates the measurement of acetabular inclination. APP = Anterior pelvic plane, fAA = functional acetabular anteversion, aAA = anatomical acetabular anteversion, fAI = functional acetabular inclination, aAI = anatomical acetabular inclination.
Figure 4
Figure 4
Influence of the Castellvi degree of LSTV on pelvic tilt and anatomical acetabular anteversion. In (a), the significant negative correlation between the degree of LSTV according to Castellvi and the pelvic tilt is given. (b) Depicts the significant positive correlation between anatomical acetabular anteversion and the degree of LSTV according to Castellvi. LSTV = Lumbosacral transitional vertebrae, PT = pelvic tilt, aAA = anatomical acetabular anteversion.
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