2 of 12 Top Hip Papers of 2024 | Effect of pelvic incidence on hip arthroscopy outcomes
Welcome to day 2 of my 12 Top Hip Papers of 2024 miniblog series. On day 2, we are going to take a look at a new paper this year that investigated the effect of pelvic incidence on hip arthroscopy outcomes.1
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2 of 12 Top Hip Papers of 2024 : The effect of pelvic incidence on outcomes after hip arthroscopy for FAI & labral tears1
Background:
- Pelvic incidence, pelvic tilt, and sacral slope are spinopelvic parameters used to describe sagittal plane alignment of the pelvis.
- Pelvic tilt and sacral slope are complementary angles, that change dynamically with body position or in response to pain or pathology.
- Pelvic incidence is a fixed morphological parameter that remains constant over an adult's life.
- Pelvic incidence = sacral slope + pelvic tilt. This means that pelvic incidence influences how a person balances their pelvis on their femoral heads, and how they transfer and share load in the sagittal plane across the lumbar spine (controlling lordosis), pelvis and hip (controlling acetabular version and femoral head coverage).
- Pelvic incidence may therefore influence outcomes of arthroscopic surgery for labral tears in the context of Femoroacetabular Impingement Syndrome (FAIS), even if the cam morphology is surgically altered to reduce impingement.
Study Aim:
- The aims of this study were to evaluate the effect of pelvic incidence, pelvic tilt, sacral slope and other parameters on post-operative outcomes after hip arthroscopy for acetabular labral tears, in the setting of FAIS.
What was done:
- A retrospective cohort study of patients who underwent primary hip arthroscopy for FAIS and acetabular labral tears.
- Pelvic incidence, pelvic tilt, sacral slope and other parameters were measured on CT or MRI for 74 participants who underwent hip arthroscopy for FAIS and labral tears. Other bony parameters were also measured. Data from a number of different patient rated outcome measures was available for determining outcomes from 3 – 24 months.
Key Findings:
Clinical Implications:
- Spinopelvic parameters do appear to influence outcomes of arthroscopic surgery for labral tears and FAIS.
- Those with high pelvic incidence (who tend to function in more posterior pelvic tilt) do more poorly after hip arthroscopy for FAIS and labral tears.
- This information may have relevance for surgical selection and also rehabilitation of patients with FAIS and labral pathology.
The group with low PI (people who tend to function in greater anterior pelvic tilt) had similar outcomes to those with moderate PI. The group with high PI (people who tend to function in a more posteriorly tilted pelvic position) had poorer outcomes after hip surgery. How do we interpret this?
It is most likely that the bone remodelling (osteoplasty) performed during arthroscopy for reducing the bony bump at the femoral head-neck junction (cam morphology) may assist those with a true ‘impingement’ mechanism, e.g., those with FAIS and excessive anterior pelvic tilt. But it may not provide as much help for those who function more in posterior pelvic tilt, because the primary mechanism may be different - increased anterior edge loading and extension related overload, rather than a primary impingement mechanism.
This means we really need to consider how we approach treatment for FAIS, both surgically and non-surgically. Many factors are likely to influence outcomes. This study suggests that one of factors that should be considered is pelvic incidence. Further prospective studies would be valuable to confirm the the importance of this parameter when determining best treatment approach for the individual.
Like to learn more about managing labral tears and Femoroacetabular Impingement Syndrome?
In this course, you can find detailed information on pathoaetiology, assessment and management of hip joint related pain (including labral tears and FAIS), and many other conditions. To learn more, take the online course, or join me in an online or face-to-face workshop.
This online course is included in Hip Academy and Hip Academy members receive discounts for online workshops.
I hope you enjoyed the infographics and key learnings from Day 2 of my 12 Top Hip Papers of 2024. There are 10 other papers to come, so keep an eye out on the graphics below, to see what other top papers and infographics I have prepared for you!
Missed paper 1? Click above to read it!
Paper 3 comes out tomorrow!
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