Effects of posterior pelvic tilt on anterior instability in total hip arthroplasty: A parametric experimental modeling evaluation

Background: Anterior dislocation is one of the concerns of patients with posterior pelvic tilt undergoing total hip arthroplasty. This study aimed to evaluate the magnitude of posterior pelvic tilt constituting a risk for anterior dislocation by measuring the range of motion until impingement and dislocation under various pelvic tilt. Methods: Using a jig mounted prosthetic hip model, the ranges of external rotation at extension and internal rotation at flexion until reaching dislocation were tested. The site of impingement prior to dislocation was also recorded. Posterior pelvic tilt and the cup version were changed with 10 degrees increments from 0 degrees to 40 degrees and from 10 degrees retroversion to 30 degrees anteversion, respectively. Effects of increasing femoral offset were also tested. We defined a required range of motion as having 30 degrees external rotation at extension and 40 degrees internal rotation at 90 degrees flexion. Findings: External rotation decreased in a posterior pelvic tilt-dependent manner. In the case with more than 20 degrees posterior pelvic tilt, available external rotation extended beyond required range with the cup anteversion of 20 degrees. Decreasing cup anteversion improved external rotation, however, internal rotation decreased simultaneously. In the case with posterior pelvic tilt more than 20 degrees, only cup anteversion with 0 degrees or 10 degrees satisfied the required range of motion. A + 4 mm horizontal offset improved external rotation by 10 degrees with delaying bony impingement. Interpretation: More than 20 degrees of posterior pelvic tilt may cause anterior instability and diminish the optimal range of cup version. Increasing the femoral offset improved external rotation without reducing internal rotation. (C) 2012 Elsevier Ltd. All rights reserved.