Does surgery change pelvic tilt?

Abstract

Aims Pelvic tilt is believed to affect the symptomology of osteoarthritis (OA) of the hip by alterations in joint movement, dysplasia of the hip by modification of acetabular cover, and femoroacetabular impingement by influencing the impingement-free range of motion. While the apparent role of pelvic tilt in hip pathology has been reported, the exact effects of many forms of treatment on pelvic tilt are unknown. The primary aim of this study was to investigate the effects of surgery on pelvic tilt in these three groups of patients. Methods The demographic, radiological, and outcome data for all patients operated on by the senior author between October 2016 and January 2020 were identified from a prospective registry, and all those who underwent surgery with a primary diagnosis of OA, dysplasia, or femoroacetabular impingement were considered for inclusion. Pelvic tilt was assessed on anteroposterior (AP) standing radiographs using the pre- and postoperative pubic symphysis to sacroiliac joint (PS-SI) distance, and the outcomes were assessed with the Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and Harris Hip Score (HHS). Results The linear regression model revealed a significant negative predictive association between the standing pre- and postoperative PS-SI distances for all three groups of patients (all p < 0.001). There was a significant improvement in all three outcome measures between the pre- and postoperative values (p < 0.05). Conclusion There is a statistically significant decrease in pelvic tilt after surgery in patients with OA of the hip, dysplasia, and femoroacetabular impingement. These results confirm that surgery significantly alters the pelvic orientation. Pelvic tilt significantly decreased after total hip arthroplasty, periacetabular osteotomy, and arthroscopy/surgical hip dislocation. The impact of surgery on pelvic tilt should be considered within the therapeutic plan in order to optimize pelvic orientation in these patients. Cite this article: Bone Joint J 2022;104-B(9):1025–1031.

Factors influencing patient-reported outcomes following periacetabular osteotomy and open osteochondroplasty in the setting of borderline hip dysplasia

“…New concepts such as correction of pelvic tilt, as well as new techniques that may improve accuracy, are emerging such as 3D cutting and reposition guides, and augmented reality. 18,49,50 Out of the six patients who had a postoperative AI < -10°, three (50%) had poor PROMs at last follow-up, and joint degeneration Tönnis II or greater at radiological follow-up.…”

Important matters that need attention

“…However, there are still very significant question marks over how and when periacetabular osteotomy should be performed, and what adjunctive treatments are needed. [21][22][23][24][25][26][27][28][29] A great deal more research is needed.…”

A leap towards personalized orthopaedic surgery and the prediction of spinopelvic mechanics in total hip arthroplasty

“…Another important aspect of this study is the change in spinopelvic mechanics after THA. 9-13 Surgeons who undertake this procedure must recognize that changes in the sagittal profile and balance could influence decisions about the functional orientation of the acetabular component. 14 Additionally, the classification proposed by Tang et al 1 may provide valuable insights into the longstanding debate regarding the sequence of surgical interventions – whether to address the hip or spine first in patients presenting with significant symptoms in both areas.…”