What is the pelvic tilt in acetabular dysplasia and does it change following peri-acetabular osteotomy?

Roussot, Mark; Salih, Saif; Grammatopoulos, George; Witt, Johan

doi:10.1093/jhps/hnab023

Cited by 14 publications

(21 citation statements)

References 45 publications

(51 reference statements)

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“…However, it is likely that one’s pelvic tilt angle cannot be altered much, as previous studies have reported that functional pelvic tilt angle does not change after successful PAO in both retroversion and dysplasia cases (ie, absent compensatory mechanisms). 16 , 37 We would thus argue that it is the functional version that has to be accounted for and treated, and that one’s spinopelvic parameters play an important role as primary determinants of the functional version.…”

Section: Discussionmentioning

confidence: 99%

Acetabular Morphology and Spinopelvic Characteristics: What Predominantly Determines Functional Acetabular Version?

DeVries

Speirs

Salih

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: In addition to the relative size of the acetabular rim and how the pelvis is positioned in space, the plane in which the acetabular version is calculated also affects its measurement. Purpose: To determine the relative contribution of pelvic and acetabular characteristics on morphological version (measured relative to the anterior pelvic plane angle [APPA]) and functional version (measured relative to the horizontal table). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 50 acetabular dysplasia patients and 109 asymptomatic controls. Using image analysis software, morphological parameters of the pelvis and acetabulum were determined from 2-dimensional computed topography: pelvic incidence, pelvic tilt angle, sacral slope, APPA, morphological and functional acetabular versions, and subtended angles (measure of acetabular rim prominence relative to the femoral head center) around the acetabular clockface in 30° increments. Correlation and multivariable regression analyses were performed with morphological and functional version as dependent variables and spinopelvic and acetabular parameters as independent variables. Results: Morphological version was moderately associated with differences between anterior and posterior subtended angles ( R = 0.68 [ P < .001] and R = 0.57 [ P < .001] for differences at 165° and 15° and 135° and 45°, respectively). Functional version was moderately associated with pelvic tilt angle ( R = 0.56; P <.001) and the difference in subtended angles between anterior and posterior rims ( R = 0.61 [ P < .001] and R = 0.50 [ P < .001] for differences at 165° and 15° and 135° and 45°, respectively). Multivariate analysis revealed a good model for predicting morphological version ( R 2 = 0.44; P < .01) and functional version ( R 2 = 0.58; P < .01). Subtended angle difference between 165° and 15° ( B = 0.36 [95% CI, 0.24-0.49]; P < .001) was most strongly related to morphological version, and pelvic tilt angle ( B = 0.57 [95% CI, 0.46-0.68]; P < .001) was most strongly related to functional version. Conclusion: Functional acetabular version was influenced most strongly by pelvic tilt angle rather than the relative prominence of the acetabular rims. Before determining surgical management for version abnormalities, it would be prudent to assess pelvic mobility and characteristics in different functional positions. In patients with minimal pelvic tilt change dynamically, corrective osteotomy would be the treatment of choice to improve functional version.

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Section: Discussionmentioning

confidence: 99%

Acetabular Morphology and Spinopelvic Characteristics: What Predominantly Determines Functional Acetabular Version?

DeVries

Speirs

Salih

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…PT was measured by the sacro-femoral-pubic (SFP) angle, and the pubic symphysis to sacroiliac (PS-SI) index, in both supine and standing AP pelvic radiographs for all 69 patients. The preoperative radiographs were also assessed for acetabular index (AI) 26 and lateral centre-edge angle (LCEA). 26 A review of the patients’ notes found that, of the 22 patients with preoperative supine and standing radiographs, 28 hips were symptomatic for acetabular retroversion.…”

Section: Methodsmentioning

confidence: 99%

“…The preoperative radiographs were also assessed for acetabular index (AI) 26 and lateral centre-edge angle (LCEA). 26 A review of the patients’ notes found that, of the 22 patients with preoperative supine and standing radiographs, 28 hips were symptomatic for acetabular retroversion. These 28 symptomatic hips were then assessed for the parameters of acetabular retroversion: crossover sign, crossover index, ischial spine sign, and posterior wall sign.…”

Section: Methodsmentioning

confidence: 99%

“…Both left and right SFP angles were measured, and where > 1° difference was obtained, the mean of the two measurements was used. 26,28 PS-SI index is the length of a line drawn from the superior border of the centre of the pubic symphysis to its intersection with the centre of the sacroiliac line (a line drawn between the inferior aspect of the sacroiliac joints) whereby a change of 1 mm in the PS-SI equates to 3.6° change in PT (Figure 2). 29…”

Section: Methodsmentioning

confidence: 99%

“…The LCEA is the angle between a vertical line passing through the centre of the femoral head, and a line passing from the centre of the femoral head to the lateral edge of the bony condensation of the sourcil. 26 The posterior wall sign is defined as present when the posterior wall of the acetabulum passes medial to the centre of the femoral head. The ischial spine sign is positive when the ischial spine is visible medial to the iliopectineal line, and the crossover sign is present when the anterior wall overlaps the posterior wall.…”

Section: Methodsmentioning

confidence: 99%

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Pelvic tilt from supine to standing in patients with symptomatic acetabular retroversion of the hip

Jenkinson

Peeters

Hutt

et al. 2022

The Bone & Joint Journal

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Aims Acetabular retroversion is a recognized cause of hip impingement and can be influenced by pelvic tilt (PT), which changes in different functional positions. Positional changes in PT have not previously been studied in patients with acetabular retroversion. Methods Supine and standing anteroposterior (AP) pelvic radiographs were retrospectively analyzed in 69 patients treated for symptomatic acetabular retroversion. Measurements were made for acetabular index (AI), lateral centre-edge angle (LCEA), crossover index, ischial spine sign, and posterior wall sign. The change in the angle of PT was measured both by the sacro-femoral-pubic (SFP) angle and the pubic symphysis to sacroiliac (PS-SI) index. Results In the supine position, the mean PT (by SFP) was 1.05° (SD 3.77°), which changed on standing to a PT of 8.64° (SD 5.34°). A significant increase in posterior PT from supine to standing of 7.59° (SD 4.5°; SFP angle) and 5.89° (SD 3.33°; PS-SI index) was calculated (p < 0.001). There was a good correlation in PT change between measurements using SFP angle and PS-SI index (0.901 in the preoperative group and 0.815 in the postoperative group). Signs of retroversion were significantly reduced in standing radiographs compared to supine: crossover index (0.16 (SD 0.16) vs 0.38 (SD 0.15); p < 0.001), crossover sign (19/28 hips vs 28/28 hips; p < 0.001), ischial spine sign (10/28 hips vs 26/28 hips; p < 0.001), and posterior wall sign (12/28 hips vs 24/28 hips; p < 0.001). Conclusion Posterior PT increased from supine to standing in patients with symptomatic acetabular retroversion. The features of acetabular retroversion were less evident on standing radiographs. The low PT angle in the supine position is a factor in the increased appearance of acetabular retroversion. Patients presenting with symptoms of hip impingement should be assessed by supine and standing pelvic radiographs to highlight signs of acetabular retroversion, and to assist with optimizing acetabular correction at the time of surgery. Cite this article: Bone Joint J 2022;104-B(7):786–791.

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Measurement of pelvic tilt and rotation on AP radiographs using HipRecon: Validation and comparison to other parameters

Heimann

Schwab

Popa

et al. 2023

Journal Orthopaedic Research

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In this paper, we present and evaluate HipRecon, a noncommercial software package that simultaneously calculates pelvic tilt and rotation from an anteroposterior pelvis radiograph. We asked: What is the (1) accuracy and precision, (2) robustness, and (3) intra‐/interobserver reliability/reproducibility of HipRecon to analyze both pelvic tilt and rotation on conventional AP pelvis radiographs? (4) How does the prediction of pelvic tilt on AP pelvis radiographs using HipRecon compare to established measurement methods? We compared the actual pelvic tilt of 20 adult human cadaveric pelvises with the calculated pelvic orientation based on an AP pelvis radiograph using HipRecon software. The pelvises were mounted on a radiolucent fixture and a total of 380 AP pelvis radiographs with different configurations were acquired. In addition, we investigated the correlation between actual tilt and the tilt calculated using HipRecon and seven other established measurement methods. The calculated software accuracy was 0.2 ± 2.0° (−3.6–4.1) for pelvic tilt and 0.0 ± 1.2° (−2.2–2.3, p = 0.39) for pelvic rotation. The Bland–Altman analysis showed values that were evenly and randomly spread in both directions. HipRecon showed excellent consistency for the measurement of pelvic tilt and rotation (intraobserver intraclass‐correlation coefficient [ICC]: 0.99 [95% CI: 0.99–0.99] and interobserver ICC 0.99 [95% CI: 0.99–0.99]). Of all eight analyzed methods, the highest correlation coefficient was found for HipRecon (r = 0.98, p < 0.001). In the future, HipRecon could be used to detect changes in patient‐specific pelvic orientation, helping to improve clinical understanding and decision‐making in pathologies of the hip.

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What is the pelvic tilt in acetabular dysplasia and does it change following peri-acetabular osteotomy?

Cited by 14 publications

References 45 publications

Acetabular Morphology and Spinopelvic Characteristics: What Predominantly Determines Functional Acetabular Version?

Acetabular Morphology and Spinopelvic Characteristics: What Predominantly Determines Functional Acetabular Version?

Pelvic tilt from supine to standing in patients with symptomatic acetabular retroversion of the hip

Measurement of pelvic tilt and rotation on AP radiographs using HipRecon: Validation and comparison to other parameters

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