Skip to main content
SpringerLink
Log in

Quantification of Pelvic Tilt in Total Hip Arthroplasty

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

In THA, anterior or posterior tilt of the pelvis changes the position of the acetabular component on the coronal plane of the body as compared with its anatomic position in the pelvic bone. To understand the occurrence and clinical importance for patients with pelvic tilt on an operating room table in the lateral decubitus position, we studied 436 patients (477 hips) undergoing primary THA using an imageless computer navigation system that measured tilt. We determined the distribution and magnitude of pelvic tilt, especially tilt of 10° or greater. The distribution of tilt had a range of 25° posterior to 20° anterior. Twenty-nine of 477 (6.1%) hips had zero tilt; 251 (52.6%) had tilt of 1° to 5°; 120 (25.2%) had tilt of 6° to 9°; and 77 (16.1%) had tilt of 10° or greater. The conversion factor for acetabular anteversion has been determined by a mathematical formula by Lembeck et al. and was confirmed by us in practice. Measurement of pelvic tilt during the performance of THA will improve the accuracy of cup position, especially allowing anteversion to be measured on the coronal plane.

Level of Evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2A–B
Fig. 3

Similar content being viewed by others

References

  1. American Standards for Testing and Materials. Annual Book of American Society for Testing and Materials Standards. Volume E177–E190a. West Conshohocken, PA: ASTM International; 2002.

    Google Scholar 

  2. Anda S, Svenningsen S, Grontvedt T, Benum P. Pelvic inclination and spatial orientation of the acetabulum: a radiographic, computed tomographic and clinical investigation. Acta Radiol. 1990;31:389–394.

    CAS  PubMed  Google Scholar 

  3. Babisch JW, Layher F, Amiot LP. The rationale for tilt-adjusted acetabular cup navigation. J Bone Joint Surg Am. 2008;90:357–365.

    Article  PubMed  Google Scholar 

  4. Chen E, Goertz W, Lill CA. Implant position calculation for acetabular cup placement considering pelvic lateral tilt and inclination. Comput Aided Surg. 2006;11:309–316.

    Article  PubMed  Google Scholar 

  5. DiGioia AM, Hafez MA, Jaramaz B, Levison TJ, Moody JE. Functional pelvic orientation measured from lateral standing and sitting radiographs. Clin Orthop Relat Res. 2006;453:272–276.

    Article  PubMed  Google Scholar 

  6. DiGioia AM, Jaramaz B, Blackwell M, Simon DA, Morgan F, Moody JE, Nikou C, Colgan BD, Aston CA, Labarca RS, Kischell E, Kanade T. The Otto Aufranc Award. Image guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop Relat Res. 1998;355:8–22.

    Article  PubMed  Google Scholar 

  7. Dorr LD. Hip Arthroplasty: Minimally Invasive Techniques and Computer Navigation. Philadelphia, PA: Saunders Elsevier; 2006.

    Google Scholar 

  8. Dorr LD, Hishiki Y, Wan Z, Newton D, Yun A. Development of imageless computer navigation for acetabular component position in total hip replacement. Iowa Orthop J. 2005;25:1–9.

    PubMed  Google Scholar 

  9. Dorr LD, Malik A, Dastane M, Wan Z. Combined anteversion technique for total hip arthroplasty. Clin Orthop Relat Res. 2009;467:119–127.

    Article  PubMed  Google Scholar 

  10. Dorr LD, Malik A, Wan Z, Long WT, Harris M. Precision and bias of imageless computer navigation and surgeon estimates for acetabular component position. Clin Orthop Relat Res. 2007;465:92–99.

    PubMed  Google Scholar 

  11. Ecker TM, Tannast M, Murphy SB. Computed tomography-based surgical navigation for hip arthroplasty. Clin Orthop Relat Res. 2007;465:100–105.

    PubMed  Google Scholar 

  12. Komeno M, Hasegawa M, Sudo A, Uchida A. Computed tomographic evaluation of component position on dislocation after total hip arthroplasty. Orthopedics. 2006;29:1104–1108.

    PubMed  Google Scholar 

  13. Lembeck B, Mueller O, Reize P, Wuelker N. Pelvic tilt makes acetabular cup navigation inaccurate. Acta Orthop. 2005;76:517–523.

    Article  PubMed  Google Scholar 

  14. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60:217–220.

    CAS  PubMed  Google Scholar 

  15. Malik A, Wan Z, Jaramaz B, Bowman G, Dorr LD. A validation model for measurement of acetabular component position. J Arthroplasty. 2009 June 22 [Epub ahead of print].

  16. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75:228–232.

    CAS  PubMed  Google Scholar 

  17. Nishihara S, Sugano N, Nishii T, Ohzono K, Yoshikawa H. Measurements of pelvic flexion angle using three-dimensional computed tomography. Clin Orthop Relat Res. 2003;411:140–151.

    Article  PubMed  Google Scholar 

  18. Parratte S, Argenson JN. Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty: a prospective, randomized, controlled study. J Bone Joint Surg Am. 2007;89:494–499.

    Article  PubMed  Google Scholar 

  19. Tannast M, Langlotz U, Siebenrock KA, Wiese M, Bernsmann K, Langlotz F. Anatomic referencing of cup orientation in total hip arthroplasty. Clin Orthop Relat Res. 2005;436:144–150.

    Article  PubMed  Google Scholar 

  20. Wan Z, Malik A, Jaramaz B, Chao L, Dorr LD. Imaging and navigation measurement of acetabular component position in THA. Clin Orthop Relat Res. 2009;467:32–42.

    Article  PubMed  Google Scholar 

  21. Widmer KH, Zurfluh B. Compliant positioning of total hip components for optimal range of motion. J Orthop Res. 2004;22:815–821.

    Article  PubMed  Google Scholar 

  22. Yoshimine F. The safe-zones for combined cup and neck anteversions that fulfill the essential range of motion and their optimum combination in total hip replacements. J Biomech. 2006;39:1315–1323.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Patricia Paul for assistance in preparing this manuscript.

Author information

Authors and Affiliations

  1. The Arthritis Institute, 637 S Lucas Avenue, 5th Floor, Los Angeles, CA, 90017, USA

    Jinjun Zhu MD, Zhinian Wan MD & Lawrence D. Dorr MD

Authors
  1. Jinjun Zhu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhinian Wan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lawrence D. Dorr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lawrence D. Dorr MD.

Additional information

One or more of the authors (LDD) have received funding from the Dorr Arthritis Research Foundation.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research and that informed consent for participation in the study was obtained.

About this article

Cite this article

Zhu, J., Wan, Z. & Dorr, L.D. Quantification of Pelvic Tilt in Total Hip Arthroplasty. Clin Orthop Relat Res 468, 571–575 (2010). https://doi.org/10.1007/s11999-009-1064-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-009-1064-7

Keywords

Search

Navigation