The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Pelvico-Sacro-L1 Angle: An Index for Rapid Evaluation of Spinopelvic Sagittal Balance

Document Type : RESEARCH PAPER

Authors
Mohammad Ayati Firoozabadi
Mohammadreza Razzaghof
Sina Esmaeili
Mohammad Zarei
Hesan Rezaee
Hamed Naghizadeh
Alireza Moharrami
SM Javad Mortazavi
Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran - Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
10.22038/abjs.2025.84981.3868
Abstract
Objectives: This study aimed to evaluate the Pelvico-Sacro-L1 angle (PSLA) as a direct parameter for assessing PI-LL mismatch as a key determinant of sagittal balance.
Methods: In this retrospective study, adult patients scheduled for total hip arthroplasty (THA) underwent spinopelvic lateral radiography. The pelvic sagittal line angle (PSLA) was defined as the angle between a line drawn from the center of the femoral head to the center of the superior endplate of S1 and the superior endplate of L1. The deviation from 90° was termed the modified PSLA, proposed as an alternative to the pelvic incidence–lumbar lordosis (PI–LL) mismatch. Two independent orthopaedic surgeons measured the spinopelvic parameters and repeated the assessments four weeks later to evaluate intraobserver reliability.
Results: A total of 92 patients (average age: 57.4 ± 9.9 years, 50 females) were included. The Bland–Altman plot indicated no significant systematic difference between the two measurement sets, suggesting good agreement between methods. The intraclass correlation coefficient (ICC) for PSLA in both inter- and intraobserver reliability was greater than 0.9, indicating excellent agreement.
Conclusion: The PSLA demonstrated a strong agreement with the PI-LL mismatch, confirming the reliability of this approach, which provides a more straightforward and easily interpretable measurement.
        Level of evidence: II
Keywords
Lumbar lordosis
Pelvic incidence
Sagittal balance
Spinopelvic
Total hip arthroplasty
Subjects

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The Archives of Bone and Joint Surgery
Volume 14, Issue 6
June 2026
Pages 394-400

  • Receive Date 28 December 2024
  • Revise Date 05 September 2025
  • Accept Date 16 June 2025