James R Ross1, Jeffrey J Nepple2, Marc J Philippon2, Bryan T Kelly3, Christopher M Larson4, Asheesh Bedi5. 1. Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA Broward Orthopedic Specialists, Fort Lauderdale, Florida, USA orthodocjimross@gmail.com. 2. Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado, USA. 3. Hospital for Special Surgery, New York, New York, USA. 4. Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, USA. 5. Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA Hospital for Special Surgery, New York, New York, USA.
Abstract
BACKGROUND: The current understanding of the effect of dynamic changes in pelvic tilt on the functional acetabular orientation and occurrence of femoroacetabular impingement (FAI) is limited. PURPOSE: To determine the effect of changes in pelvic tilt on (1) terminal hip range of motion and (2) measurements of acetabular version as assessed on 2- and 3-dimensional imaging. STUDY DESIGN: Controlled laboratory study. METHODS: Preoperative pelvic computed tomographic scans of 48 patients (50 hips) who underwent arthroscopic surgery for the treatment of FAI were analyzed. The mean age of the study population was 25.7 years (range, 14-56 years), and 56% were male. Three-dimensional models of the hips were created, allowing manipulation of the pelvic tilt and simulation of hip range of motion to osseous contact. Acetabular version was measured and the presence of the crossover sign, prominent ischial spine sign, and posterior wall sign was recorded on simulated plain radiographs. Measurements of range of motion to bony impingement during (1) hip flexion, (2) internal rotation in 90° of flexion, and (3) internal rotation in 90° of flexion and 15° adduction were performed, and the location of bony contact between the proximal femur and acetabular rim was defined. These measurements were calculated for -10° (posterior), 0° (native), and +10° (anterior) pelvic orientations. RESULTS: In native tilt, mean cranial acetabular version was 3.3°, while central version averaged 16.2°. Anterior pelvic tilt (10° change) resulted in significant retroversion, with mean decreases in cranial and central version of 5.9° and 5.8°, respectively (P < .0001 for both). Additionally, this resulted in a significantly increased proportion of positive crossover, posterior wall, and prominent ischial spine signs (P < .001 for all). Anterior pelvic tilt (10° change) resulted in a decrease in internal rotation in 90° of flexion of 5.9° (P < .0001) and internal rotation in 90° of flexion and 15° adduction of 8.5° (P < .0001), with a shift in the location of osseous impingement more anteriorly. Posterior pelvic tilt (10° change) resulted in an increase in internal rotation in 90° of flexion of 5.1° (P < .0001) and internal rotation in 90° of flexion and 15° adduction of 7.4° (P < .0001), with a superolateral shift in the location of osseous impingement. CONCLUSION/CLINICAL RELEVANCE: Dynamic changes in pelvic tilt significantly influence the functional orientation of the acetabulum and must be considered. Dynamic anterior pelvic tilt is predicted to result in earlier occurrence of FAI in the arc of motion, whereas dynamic posterior pelvic tilt results in later occurrence of FAI, which may have implications regarding nonsurgical treatments for FAI.
BACKGROUND: The current understanding of the effect of dynamic changes in pelvic tilt on the functional acetabular orientation and occurrence of femoroacetabular impingement (FAI) is limited. PURPOSE: To determine the effect of changes in pelvic tilt on (1) terminal hip range of motion and (2) measurements of acetabular version as assessed on 2- and 3-dimensional imaging. STUDY DESIGN: Controlled laboratory study. METHODS: Preoperative pelvic computed tomographic scans of 48 patients (50 hips) who underwent arthroscopic surgery for the treatment of FAI were analyzed. The mean age of the study population was 25.7 years (range, 14-56 years), and 56% were male. Three-dimensional models of the hips were created, allowing manipulation of the pelvic tilt and simulation of hip range of motion to osseous contact. Acetabular version was measured and the presence of the crossover sign, prominent ischial spine sign, and posterior wall sign was recorded on simulated plain radiographs. Measurements of range of motion to bony impingement during (1) hip flexion, (2) internal rotation in 90° of flexion, and (3) internal rotation in 90° of flexion and 15° adduction were performed, and the location of bony contact between the proximal femur and acetabular rim was defined. These measurements were calculated for -10° (posterior), 0° (native), and +10° (anterior) pelvic orientations. RESULTS: In native tilt, mean cranial acetabular version was 3.3°, while central version averaged 16.2°. Anterior pelvic tilt (10° change) resulted in significant retroversion, with mean decreases in cranial and central version of 5.9° and 5.8°, respectively (P < .0001 for both). Additionally, this resulted in a significantly increased proportion of positive crossover, posterior wall, and prominent ischial spine signs (P < .001 for all). Anterior pelvic tilt (10° change) resulted in a decrease in internal rotation in 90° of flexion of 5.9° (P < .0001) and internal rotation in 90° of flexion and 15° adduction of 8.5° (P < .0001), with a shift in the location of osseous impingement more anteriorly. Posterior pelvic tilt (10° change) resulted in an increase in internal rotation in 90° of flexion of 5.1° (P < .0001) and internal rotation in 90° of flexion and 15° adduction of 7.4° (P < .0001), with a superolateral shift in the location of osseous impingement. CONCLUSION/CLINICAL RELEVANCE: Dynamic changes in pelvic tilt significantly influence the functional orientation of the acetabulum and must be considered. Dynamic anterior pelvic tilt is predicted to result in earlier occurrence of FAI in the arc of motion, whereas dynamic posterior pelvic tilt results in later occurrence of FAI, which may have implications regarding nonsurgical treatments for FAI.
Authors: Miguel O Castro; Vasco V Mascarenhas; P Diana Afonso; Paulo Rego; Florian Schmaranzer; Reto Sutter; Ara Kassarjian; Luca Sconfienza; Michael Dienst; Olufemi R Ayeni; Paul E Beaulé; Pedro Dantas; Radhesh Lalam; Marc-André Weber; Filip M Vanhoenacker; Tobias Johannes Dietrich; Lennart Jans; Philip Robinson; Apostolos H Karantanas; Iwona Sudoł-Szopińska; Suzanne Anderson; Iris Noebauer-Huhmann; Oliver Marin-Peña; Diego Collado; Marc Tey-Pons; Ehrenfried Schmaranzer; Mario Padron; Josef Kramer; Patrick O Zingg; Michel De Maeseneer; Eva Llopis Journal: Eur Radiol Date: 2021-01-07 Impact factor: 5.315
Authors: Jeffrey J Nepple; Joel Wells; James R Ross; Asheesh Bedi; Perry L Schoenecker; John C Clohisy Journal: Clin Orthop Relat Res Date: 2017-04 Impact factor: 4.176
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