Femoropelvilumbal complex – anatomical and radiological notes

Česká verze

Authors: I. Vařeka ^{1 3}; R. Dvořák ³
Authors place of work: FN HRADEC KRÁLOVÉ ¹; Lékařská fakulta, Univerzita Karlova, Hradec Králové ²; Fakulta tělesné kultury, Univerzita Palackého v Olomouci ³
Published in the journal: Rehabil. fyz. Lék., 105, 2025, No. 2, pp. 67-72.
Category: Přehledový článek
doi: https://doi.org/10.48095/ccrhfl202567

Summary

The connection of the pelvis with the adjacent areas of the locomotor system, i.e. with the femurs and lumbar spine, is a key area for the position of the lower limbs and the alignment of the trunk in standing and walking. Significant factors in the alignment of the hip-pelvic-lumbar complex (FPLC) include the collo-diaphyseal angle, offset and anteversion of the neck, ante-inclination of the acetabulum, degree of coverage of the head by the acetabulum, type of sacroiliac joint, as well as degree of anteversion of the pelvis and curvature of the lumbar lordosis, together with varying degrees of wedging of the caudal lumbar vertebrae and degree of openness of the prezygapophyseal angles. Sexual dimorphism is clearly manifested in this area because of the need to ensure the passage of a relatively large head during childbirth. Knowledge of anatomical relationships and radiological parameters is important for understanding the functional relationships within the FPLC as well as functional connections to other parts of the locomotor system and their clinical consequences.

Keywords:

Anatomy – Pelvis – Hip – Spine

Zdroje

Vařeka I, Dvořák R. Femoropelvilumbální komplex – funkční vztahy a klinika. Rehabil Fyz Lek. In press 2025.
Hogervorst T, Bouma HW, de Vos J. Evolution of the hip and pelvis. Acta Orthop Suppl 2009; 80(336): 1–39. doi: 10.1080/17453690610046620.
Stloukal M. Změny velikostí úhlu femuru od pravěku do současnosti. In: Čížka V, Hněvkovský O, Jaroš M (eds). Chirurgie kyčelního kloubu. Praha: SZN 1957: 61–70.
Heřt J, Barták V, Fulín P et al. Does the femoral CCD angle measurement in a standard ap projection correlate with the true anatomical shape of the femur? Acta Chir Orthop Traumatol Cech 2021; 88(3): 169–175.
Müller ME. Die Hüftnahen Femurosteotomien. Stuttgart: Gustav Thieme Verlag 1957.
Waldt S, Wörtler K. Measurements and classifications in musculoskeletal radiology. Stuttgart: Georg Thieme Verlag 2014.
Fischer CS, Kühn JP, Völzke H et al. The neckshaft angle: an update on reference values and associated factors. Acta Orthop 2020; 91(1): 53–57. doi: 10.1080/17453674.2019.1690873.
Mayr E, Thaler M, Williams A et al. The figure-of--four axis as a reference to determine stem rotation in hip arthroplasty. What does it really measure? A cadaver study. Acta Orthop 2007; 78(4): 458–462. doi: 10.1080/17453670710014086.
Yoshioka Y, Cooke TD. Femoral anteversion: assessment based on function axes. J Orthop Res 1987; 5(1): 86–91. doi: 10.1002/jor.1100050111.
Souza AD, Ankolekar VH, Padmashali S et al. Femoral neck anteversion and neck shaft angles: determination and their clinical implications in fetuses of different gestational ages. Malays Orthop J 2015; 9(2): 33–36. doi: 10.5704/ MOJ.1507.009.
Scorcelletti M, Reeves ND, Rittweger J et al. Femoral anteversion: significance and measurement. J Anat 2020; 237(5): 811–826. doi: 10.1111/joa.13249.
Cibulka MT. Determination and significance of femoral neck anteversion. Phys Ther 2004; 84(6): 550–558. doi: 10.1093/ptj/84.6.550.
Schmaranzer F, Lerch TD, Siebenrock KA et al. Differences in femoral torsion among various measurement methods increase in hips with excessive femoral torsion. Clin Orthop Relat Res 2019; 477(5): 1073–1083. doi: 10.1097/ CORR.0000000000000610.
Werking K, Böhme N. Einsatz der Computertomografie in orthopädischen Messverfahren. Radiopraxis 2013; 6(3): 143–152. doi: 10.1055/s-0033-1344388.
Alvik I. Increased anteversion of the femoral neck as sole sign of dysplasia coxae. Acta Orthop Scand 1959; 29(1–4): 301–306. doi: 10.3109/17453675908988805.
Gulan G, Matovinović D, Nemec B. Femoral neck anteversion: values, development, measurement, common problems. Coll Antropol 2000; 24(2): 521–527.
Lecerf G, Fessy MH, Philippot R et al. Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res 2009; 95(3): 210–219. doi: 10.1016/j. otsr.2009.03.010.
Flecher X, Ollivier M, Argenson JN. Lower limb length and offset in total hip arthroplasty. Orthop Traumatol Surg Res 2016; 102(1 Suppl): S9–20. doi: 10.1016/j.otsr.2015.11.001.
Matsubayashi S, Isobe Y, Chiba K et al. Measurement of femoral axial offset. J Orthop Res 2021; 39(7): 1383–1389. doi: 10.1002/jor.24843.
Müller O, Reize P, Trappmann D et al. Measuring anatomical acetabular cup orientation with a new X-ray technique. Comput Aid Surg 2006; 11(2): 69–75. doi: 10.3109/10929080600640618.
Kim JT, Shen QH, Jeon CH et al. No linear correlation between pelvic incidence and acetabular orientation: retrospective observa tional study. Medicine (Baltimore) 2021; 100(15): e25445. doi: 10.1097/MD.0000000000025445.
Lazennec JY, Rousseau MA, Brusson A et al. Total hip prostheses in standing, sitting and squatting positions: an overview of our 8 years practice using the EOS imaging technology. Open Orthop J 2015; 9: 26–44. doi: 10.2174/1874325001509010026.
Wang RY, Xu WH, Kong XC et al. Measurement of acetabular inclination and anteversion via CT generated 3D pelvic model. BMC Musculoskel Disord 2017; 18(1): 373. doi: 10.1186/ s12891-017-1714-y.
Imai N, Suzuki H, Nozaki A et al. Correlation of tilt of the anterior pelvic plane angle with anatomical pelvic tilt and morphological configuration of the acetabulum in patients with developmental dysplasia of the hip: a cross-sectional study. J Orthop Surg Res 2019; 14(1): 323. doi: 10.1186/s13018-019-1382-8.
Di Martino A, Geraci G, Brunello M et al. Hip-spine relationship: clinical evidence and biomechanical issues. Arch Orthop Trauma Surg 2024; 144(4): 1821–1833. doi: 10.1007/ s00402-024-05227-3.
McCurdy M, Lee Y, DiNicola G et al. The hip spine relationship—what we know and what we don’t: a narrative review. AME Med J 2024; 9: 6. doi: 10.21037/amj-23-163.
Rivière C, Maillot C, Harman C et al. Kinematic alignment technique for total hip arthroplasty. Semin Arthroplast 2018; 29(4): 330–343. doi: 10.1053/j.sart.2019.05.008.
Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br 1993; 75(2): 228–232. doi: 10.1302/0301-620X.75B2.8444942.
Cerveri P, Marchente M, Chemello C et al. Advanced computational framework for the automatic analysis of the acetabular morphology from the pelvic bone surface for hip arthroplasty applications. Ann Biomed Eng 2011; 39(11):2791–2806. doi: 10.1007/s10439-011-0375-5.
Bergiers S, Hothi H, Henckel J et al. The in vivo location of edge-wear in hip arthroplasties: combining pre-revision 3D CT imaging with retrieval analysis. Bone Joint Res 2021; 10(10): 639–649. doi: 10.1302/2046-3758.1010.BJR-2021-0132.R1.
Lee C, Jang J, Kim HW et al. Three-dimensional analysis of acetabular orientation using a semi-automated algorithm. Comput Assist Surg (Abingdon) 2019; 24(1): 18–25. doi: 10.1080/24699322.2018.1545872.
Lawrence AB, Hammond AS, Ward CV. Acetabular orientation, pelvic shape, and the evolution of hominin bipedality. J Hum Evol 2025; 200(12): 103633. doi: 10.1016/j. jhevol.2024.103633.
Stefl M, Lundergan W, Heckmann N et al. Spinopelvic mobility and acetabular component position for total hip arthroplasty. Bone Joint J 2017; 99-B(1 Suppl A): 37–45. doi: 10.1302/0301620X.99B1.BJJ-2016-0415.R1.
Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br 1993; 75(2): 228–232. doi: 10.1302/0301-620X.75B2.8444942.
Reynolds, D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br 1999; 81(2): 281–288. doi: 10.1302/0301-620x.81b2.8291.
Park YS, Shin WC, Lee SM et al. The best method for evaluating anteversion of the acetabular component after total hip arthroplasty on plain radiographs. J Orthop Surgery Res 2018; 13(1): 66. doi: 10.1186/s13018-018-0767-4.
Phan D, Bederman SS, Schwarzkopf R. The influence of sagittal spinal deformity on anteversion of the acetabular component in total hip arthroplasty. Bone Joint J 2015; 97-B(8): 1017– 1023. doi: 10.1302/0301-620X.97B8.35700.
Dario LR, Michele S, Filippo B. Sacro-Femoral-Pubic Angle and acetabular cup anteversion in total hip arthroplasty. EC Orthop 2019; 10(6): 429–437.
Heckmann ND, Lieberman JR. Spinopelvic biomechanics and total hip arthroplasty: a primer for clinical practice. J Am Acad Orthop Surg 2021; 29(18): e88801–e903. doi: 10.5435/ JAAOS-D-20-00953.
Yang G, Li Y, Zhang, H. The influence of pelvic tilt on the anteversion angle of the acetabular prosthesis. Orthop Surg 2019; 11(5): 762–769. doi: 10.1111/os.12543.
Radcliff KE, Kepler CK, Hellman M et al. Does spinal alignment influence acetabular orientation: a study of spinopelvic variables and sagittal acetabular version. Orthop Surg 2014; 6(1): 15– 22. doi: 10.1111/os.12090.
Reikerås O, Bjerkreim I, Kolbenstvedt A. Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip. Acta Orthop Scand 1983; 54(1): 18–23. doi: 10.3109/17453678308992864.
Reid GD, Reid CG, Widmer N et al. Femoroacetabular impingement syndrome: an underrecognized cause of hip pain and premature osteoarthritis? J Rheumatol 2010; 37(7): 13951404. doi: 10.3899/jrheum.091186.
Klasan A, Neri T, Sommer C et al. Analysis of acetabular version: Retroversion prevalence, age, side and gender correlations. J Orthop Translat 2019; 18: 7–12. doi: 10.1016/j. jot.2019.01.003.
Sautet P, Giorgi H, Chabrand P et al. Is anatomic acetabular orientation related to pelvic morphology? CT analysis of 150 healthy pelvises. Orthop Traumatol Surg Res 2018; 104(3): 347–351. doi: 10.1016/j.otsr.2017.10.006.
Li LY, Zhang LJ, Zhao Q et al. Measurement of acetabular anteversion in developmental dysplasia of the hip in children by twoand three-dimensional computed tomography. J Int Med Res 2009; 37(2): 567–575. doi: 10.1177/147323000903700234.
Kapandji AI. The physiology of the joints: annotated diagrams of the mechanics of the human joints. Volume 2, The Lower Limb. Edinburgh: Churchill Livingstone 1987.
Tallroth K, Lepistö J. Computed tomography measurement of acetabular dimensions: Normal values for correction of dysplasia. Acta Orthop 2006; 77(4): 598–602. doi: 10.1080/17453670610012665.
Zingg PO, Werner CM, Sukthankar A et al. The anterior center edge angle in Lequesne‘s false profile view: interrater correlation, dependence on pelvic tilt and correlation to anterior acetabular coverage in the sagital plane. A cadaver study. Arch Orthop Trauma Surg 2009; 129(6): 787–791. doi: 10.1007/s00402-008-0694-7.
Monazzam S, Williams KA, Shelton TJ et al. Anterior centre-edge angle on sagittal CT: a comparison of normal hips to dysplastic hips. Hip Int 2018; 28(5): 535–541. doi: 10.1177/1120700017752569.
Wu CC. Does pelvic width influence patellar tracking? A radiological comparison between sexes. Orthop Traumatol Surg Res 2015; 101(2): 157–161. doi: 10.1016/j.otsr.2014.07.037.
Kiapour A, Joukar A, Elgafy H et al. Biomechanics of the Sacroiliac joint: anatomy, function, biomechanics, sexual dimorphism, and causes of pain. Int J Spine Surg 2020; 14(Suppl 1): 3–13. doi: 10.14444/6077.
Vařeka I. Hodnocení orientace pánve, typu zakřivení páteře a držení těla v sagitální rovině. Rehabil Fyz Lek 2025; 32(1): 32–39. doi: 10.48095/ccrhfl202532.
Lewit K. Manipulační léčba v rámci léčebné rehabilitace. Praha: Nakladatelství dopravy a spojů 1990.
Savarese LG, Menezes-Reis R, Bonugli GP et al. Spinopelvic sagittal balance: what does the radiologist need to know? Radiol Bras 2020; 53(3): 175–184. doi: 10.1590/0100-3984.2019.0048.
Morimoto T, Kobayashi T, Tsukamoto M et al. Hip-Spine syndrome: a focus on the pelvic incidence in hip disorders. J Clin Med 2023; 12(5): 2034. doi: 10.3390/jcm12052034.
Schlösser TP, Janssen MM, Vrtovec T et al. Evolution of the ischio-iliac lordosis during natural growth and its relation with the pelvic incidence. Eur Spine J 2014; 23(7): 1433–1441. doi: 10.1007/s00586-014-3358-z.
Lum ZC, Coury JG, Cohen JL et al. The current knowledge on spinopelvic mobility. J Arthroplasty 2018; 33(1): 291–296. doi: 10.1016/j. arth.2017.08.013.
Rivière C, Lazennec JY, Van Der Straeten C et al. The influence of spine-hip relations on total hip replacement: A systematic review. Orthop Traumat: Surg Res 2017; 103(4): 559–568. doi: 10.1016/j.otsr.2017.02.014.
Ramchandran S, Buckland A, Errico TJ. Pelvic Incidence (PI) is more easily understood as the Pelvic Base Angle (PBA). Spine Res 2017; 3(1): 8. doi: 10.21767/2471-8173.100022.
Lazennec JY, Thauront F, Robbins CB et al. Acetabular and femoral anteversions in standing position are outside the proposed safe zone after total hip arthroplasty. J Arthroplasty 2017; 32(11): 3550–3556. doi: 10.1016/j. arth.2017.06.023.
Foreman P, Griessenauer CJ, Watanabe K et al. L5 spondylolysis/spondylolisthesis: a comprehensive review with an anatomic focus. Childs Nerv Syst 2013; 29(2): 209–216. doi: 10.1007/s00381-012-1942-2.