The Investigation of Association between the Spino-Pelvic Sagittal Alignment and Knee Osteoarthritis in Middle-Aged and Elderly People: Protocol for a Systematic Review

Document Type : Review Articles

Authors
Mehrab Aghajantabar-Bozroudi 1
Javid Mostamand 2
Tayebeh Roghani 3
Alireza Rahimi 4
1 MSc Student, Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
2 Professor, Musculoskeletal Research Center AND Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
3 Assistant professor, Musculoskeletal Research Center AND Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
4 Associate professor, Department of Medical Library and Information Science, School of Health Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
10.48305/jrrs.2026.46689.1158
Abstract
Introduction: Knee osteoarthritis is one of the most common chronic joint diseases associated with pain and decreased physical function in middle-aged and elderly people. Spino-pelvic sagittal alignment, similar to the knee, undergoes age-related changes. In adults, spino-pelvic sagittal alignment and lower limb joints are important for maintaining proper posture and standing balance. Knee flexion has been reported as the most important compensatory mechanism in response to sagittal changes in the spine. Based on preliminary evidence of knee-spine syndrome, recent studies have investigated the relationship between spino-pelvic alignment and knee osteoarthritis, but the effect of spino-pelvic sagittal alignment on osteoarthritis is unclear. This protocol aims to conduct a systematic review investigating the relationship between spino-pelvic sagittal alignment and knee osteoarthritis in middle-aged and elderly individuals.
Materials and Methods: This is a systematic review protocol following PRISMA-P. Searches will be conducted in international and national databases. All Persian and English studies performed in this field (from the first to the last relevant study, until the end of 2025) will be selected. Study quality will be assessed using NHLBI and JBI checklists. All steps will be performed independently by two investigators; in case of disagreement, a third investigator's opinion will be the determining factor. To ensure the initial analysis is unbiased, two research team members will extract data from each article separately. Afterward, in a consensus, data extraction forms will be analyzed and revised as necessary, and team members' opinions will be reviewed in these cases, and the final decision to include each article will be made with the research team's agreement. After this stage, final results of the systematic review will be presented in tables and text.
Keywords
Knee osteoarthritis
Sagittal alignment
Spine
Pelvis
Subjects
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