{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:09:06Z","timestamp":1790885346973,"version":"4.1.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to investigate the association between lumbar lordosis (LL) and the sagittal hip-knee-ankle angle (sHKA) in patients with knee osteoarthritis (KOA) and to quantify the mediating effect of the sacral slope (SS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study enrolled 507 participants (left-side 302, right-side 205). Lateral full-length X-ray films of the lower extremities in weight-bearing position were collected from the research participants to measure radiological parameters such as lumbar lordosis (LL), sacral slope (SS), and sagittal hip-knee-ankle angle (sHKA), and SF-12 (12-items Short Form Health Survey) and WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores were also collected. Correlation analysis and Bootstrap mediation effect analysis were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 507 KOA participants, LL was positively correlated with SS, HKA, sHKA, and SF-12 scores, and negatively correlated with JLCA and WOMAC scores. The mediation analysis revealed that SS accounted for 10.74% of the total association of LL on sHKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with KOA, LL is closely related to sHKA, and this statistical association may be partially mediated by SS. This highlights the importance of adopting a \u201cspine-pelvis-knee\u201d perspective when assessing and treating KOA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fbioe.2026.1760345","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T06:42:34Z","timestamp":1771569754000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The mediating role of sacral slope in the relationship between lumbar lordosis and knee alignment in knee osteoarthritis: an imaging study"],"prefix":"10.3389","volume":"14","author":[{"given":"Binghua","family":"Zhang","sequence":"first","affiliation":[{"name":"Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]},{"name":"Department of Orthopaedics, Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]},{"name":"Hebei Key Laboratory of Turbidity Toxin Syndrome","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youyue","family":"Pang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yicong","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shilin","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuntao","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongwang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangqing","family":"Du","sequence":"additional","affiliation":[{"name":"Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]},{"name":"Department of Orthopaedics, Hebei Provincial Hospital of Chinese Medicine","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1985","DOI":"10.1016\/S0140-6736(18)31064-X","article-title":"Osteoarthritis","volume":"391","author":"Barnett","year":"2018","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.gaitpost.2017.04.041","article-title":"Analysis of compensatory mechanisms in the pelvis and lower extremities in patients with pelvic incidence and lumbar lordosis mismatch","volume":"56","author":"Cheng","year":"2017","journal-title":"Gait Posture"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1302\/0301-620X.102B9.BJJ-2019-1315.R2","article-title":"Unravelling the knee-hip-spine trilemma from the CHECK study: the relation between sagittal pelvic morphology and onset of degenerative knee, hip, and spine disorders","author":"Erp","year":"2020","journal-title":"Bone Jt. 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