The Effect of Pelvic Tilt on Radiographic Markers of Acetabular Coverage

Henebry, Andrew; Gaskill, Trevor R.

doi:10.1177/0363546513500632

Cited by 66 publications

(60 citation statements)

References 18 publications

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“…The results are contradictory for many parameters (Table 6). Although some authors reported an inert behavior of the LCE angle [3,10], others found variability depending on pelvic positioning [5,7,11]. Similar inconsistencies are reported for the total femoral coverage, acetabular index, and the Sharp angle ( Table 6).…”

Section: Discussionsupporting

confidence: 60%

“…On the AP pelvic radiograph, the projected anatomy of the acetabulum directly depends on pelvic tilt and rotation during radiograph acquisition. Several parameters, including Wiberg's lateral center-edge (LCE) angle [5,7,11] and the acetabular index [5,11], have been shown to change with pelvic orientation. However, in clinical practice and in the vast majority of scientific publications related to this topic, parameters are usually measured regardless of the individual pelvic orientation.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Which Radiographic Hip Parameters Do Not Have to Be Corrected for Pelvic Rotation and Tilt?

Tannast

Fritsch

Zheng

et al. 2015

Clinical Orthopaedics &Amp; Related Research

129

112

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Background Acetabular anatomy on AP pelvic radiographs depends on pelvic orientation during radiograph acquisition. However, not all parameters may change to a clinically relevant degree with differences in pelvic orientation. This issue may influence the diagnosis of acetabular pathologies and planning of corrective acetabular surgery (reorientation or rim trimming). However, to this point, it has not been well characterized. Questions/purposes We asked (1) which radiographic parameters change in a clinical setting when normalized to neutral pelvic orientation; (2) which parameters do not change in an experimental setting when the pelvis is experimentally rotated/tilted; and (3) which of these changes are ''ultimately'' relevant based on a prespecified definition of relevance. Methods In a clinical setup, 11 hip parameters were evaluated in 101 patients (126 hips) by two observers and the interobserver difference was calculated. All parameters were normalized to an anatomically defined neutral pelvic orientation with the help of a lateral pelvic radiograph and specific software. Differences between nonnormalized and normalized values were calculated (effect of normalization). In an experimental setup involving 20 cadaver pelves (40 hips), the maximum range for each parameter was computed with the pelvis rotated (range, À12°to 12°) and tilted (range, À24°to 24°). ''Ultimately'' relevant changes existed if the effect of normalization exceeded the interobserver difference (eg, 37% versus 6% for prevalence of a positive crossover sign) and/or the maximum experimental range exceeded 1 SD of interobserver difference (eg, 27% versus 6% for anterior acetabular coverage). Results In the clinical setup, all parameters except the ACM angle and craniocaudal acetabular coverage changed when being normalized, eg, effect of normalization for lateral center-edge angle, acetabular index, and sharp angle ranged from À5°to 4°(p values \ 0.029). In the experimental setup, five parameters showed no major changes, whereas six parameters did change (all p values \ 0.001). Ultimately relevant changes were found for anteroposterior acetabular coverage, retroversion index, and prevalence of a positive crossover or posterior wall sign. Conclusions Lateral center-edge angle, ACM angle, Sharp angle, acetabular and extrusion index, and craniocaudal acetabular coverage showed no relevant changes with varying pelvic orientation and can therefore be acquired independent from individual pelvic tilt and

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Which Radiographic Hip Parameters Do Not Have to Be Corrected for Pelvic Rotation and Tilt?

Tannast

Fritsch

Zheng

et al. 2015

Clinical Orthopaedics &Amp; Related Research

129

112

View full text Add to dashboard Cite

show abstract

“…In 2003, Siebenrock et al [9] reported that pelvic tilt can affect the presence of the ischial spine sign and crossover sign. Since then, a couple studies have shown the effect of pelvic tilt on radiographic measurements of pincer impingement with increasing anterior tilt associated with more radiographic signs of pincer impingement [4,7]. These changes in radiographic parameters highlight the importance of pelvic position as it relates to pincer impingement.…”

Section: Introductionmentioning

confidence: 99%

“…Standing radiographs may represent a more natural, functional pelvic position and may be more clinically relevant in the diagnosis and treatment of FAI, more specifically in patients who may have pincer impingement. The difference between supine and standing AP pelvis radiographs on pelvic tilt and these effects on the evaluation of pincer impingement have been studied in patients with dysplasia and more recently in patients with FAI [4,8]. In a comparison of supine CT versus standing radiographs, Ross et al [8] found an increase in anteversion in the supine reconstructed CT scans; however, they were unable to show a difference in crossover sign, ischial spine sign, and posterior wall sign.…”

Section: Introductionmentioning

confidence: 99%

“…They did not measure LCE angle or inclination [8]. A cadaveric laboratory study showed differences in LCE angle, inclination, and crossover sign with increasing pelvic tilt [4]. However, we are not aware of any study that has directly compared supine and standing plain radiographs in patients with respect to LCE angle, acetabular inclination, crossover sign, and ischial spine sign.…”

Section: Introductionmentioning

confidence: 99%

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Supine and Standing AP Pelvis Radiographs in the Evaluation of Pincer Femoroacetabular Impingement

Jackson¹,

Estess²,

Adamson³

2016

Clinical Orthopaedics &Amp; Related Research

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Background Pelvic tilt can affect the presence of the ischial spine sign and crossover sign. Numerous studies of pelvic tilt on radiographic measurements of pincer impingement have shown that increasing anterior tilt is associated with more radiographic signs of pincer impingement. However, to our knowledge, no study has directly compared supine and standing plain radiographs in patients with respect to lateral center-edge (LCE) angle, acetabular inclination, crossover sign, and ischial spine sign. Questions/purposes The purpose of this study was to evaluate the differences in supine and standing AP pelvis radiographs as they relate to the radiographic parameters of pincer impingement in an adult population evaluated for femoroacetabular impingement, specifically intrapelvic distances (sacrococcygeal to symphysis [SC-S] and coccyx tip to symphysis [T-S]), crossover sign (presence and percentage), LCE angle, inclination, and ischial spine sign.Methods Between August 2013 and June 2014, we obtained supine and standing radiographs for all new patients younger than 60 years who were evaluated for hip pain, when the diagnosis of fracture was not being considered; these formed the basis of this retrospective study. Patients were excluded if they had arthritis (Tönnis grade C 2), lumbar fusion, previous hip surgery, or malrotated films. Forty-six hips, symptomatic side, met the inclusion criteria (age of patients, 33 ± 14 years; 13 males, 33 females). Radiographic data that were collected included SC-S distance, T-S distance, LCE angle, acetabular inclination, presence and percentage of crossover sign, and presence of ischial spine sign. A paired t-test was used to compare continuous variables and chi-square test was used for categorical variables. Two independent readers performed measurements.Results From supine to standing films, the T-S distance decreased from 19 ± 18 mm to 6 ± 19 mm (p \ 0.001), and SC-S distance decreased from 47 ± 19 mm to 32 ± 20 mm (p \ 0.001), indicating less pelvic tilt in the standing position. The number of hips that had crossover signs decreased from supine (n = 18, 39%) to standing (n = 9, 20%) (p = 0.039). The amount of crossover decreased from 23% ± 10% to 11% ±13% (p \ 0.001). LCE angle did not change (27°± 7°to 27°± 8°) (p = 0.64) and inclination angle increased by a small amount (4.2°± 5°to 5.3°± 5°) (p = 0.002). The ischial spine sign decreased from supine (n = 20, 43%) to standing (n = 7, 15%) position (p = 0.003). Conclusions There is a decrease in the amount of pelvic tilt on standing AP pelvis radiographs resulting in a decrease in the incidence and amount of crossover sign and ischial spine sign, and a small increase in inclination. Standing radiographs should be the standard in evaluation of nonarthritic hip pain, specifically pincer femoroacetabular impingement. Surgeons should use caution in

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The effect of pelvic tilt on three‐dimensional coverage of the femoral head: A computational simulation study using patient‐specific anatomy

Uemura

Atkins

Peters

et al. 2019

The Anatomical Record

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Improved understanding of how three‐dimensional (3D) femoral head coverage changes as the pelvic sagittal inclination (PSI) is altered would advance clinical diagnosis of hip pathoanatomy. Herein, we applied computer modeling of 3D computed tomography reconstructions of the pelvis and proximal femur to quantify relationships between the PSI and regional 3D femoral head coverage. Eleven healthy, young adult participants with typically developed hip anatomy were analyzed. The orientation of the pelvis was altered to define a PSI of −30° to 30° at 1° increments. Hip adduction and rotation were fixed in a standing position, which was measured by direct in vivo imaging of the pelvis and femur bones using dual fluoroscopy. Femoral head coverage was quantified in the anterior, superior, posterior, and inferior regions for each PSI position. Change in coverage was largest in the anterior region (29.8%) and smallest in the superior region (6.5%). Coverage increased linearly in the anterior region as the PSI increased, while a linear decrease was found in the posterior region and the inferior region (all p < .001). The slopes of the regression line for these regions were 0.513, −0.316, and −0.255, respectively. For the superior region, coverage increased when the PSI was altered from −30° to 5° and decreased when the PSI was larger than 5°. Overall, a 1° increase in PSI resulted in an increase of 0.5% in anterior coverage and a decrease of 0.3% in posterior coverage. Our findings provide baseline data that improve understanding of the effect of PSI on femoral coverage.

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The Effect of Pelvic Tilt on Radiographic Markers of Acetabular Coverage

Abstract: Given the known individual and positional pelvic tilt variability, standing anteroposterior pelvic radiographs may provide a more physiological representation of acetabular coverage in the young adult population.

Cited by 66 publications

References 18 publications

Which Radiographic Hip Parameters Do Not Have to Be Corrected for Pelvic Rotation and Tilt?

Which Radiographic Hip Parameters Do Not Have to Be Corrected for Pelvic Rotation and Tilt?

Supine and Standing AP Pelvis Radiographs in the Evaluation of Pincer Femoroacetabular Impingement

The effect of pelvic tilt on three‐dimensional coverage of the femoral head: A computational simulation study using patient‐specific anatomy

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