Measurement of the normal contralateral hip flexion angle and posterior pelvic tilt angle using a pelvic guide pin in total hip arthroplasty

Background: We aimed to measure the posterior pelvic tilt angle at maximum hip flexion and hip flexion range of motion at the femoroacetabular joint using a pelvic guide pin and to examine the difference in flexion range of motion when determined by a physical therapist and under anesthesia.Methods: Data of 83 consecutive patients undergoing primary unilateral total hip arthroplasty were assessed. Using a pin inserted into the iliac crest to define the cup placement angle under anesthesia before and after total hip arthroplasty, the posterior pelvic tilt angle was determined as the change in pin tilt from the supine position to maximum hip flexion. Flexion range of motion under anesthesia was calculated as the difference in the angle between the trunk and thigh at maximum flexion and the posterior pelvic tilt angle. Flexion range of motion with a fixed pelvis measured preoperatively by a physical therapist was compared to that under anesthesia. A goni-ometer was used for all measurements and the number of measurements was one.Findings: Mean posterior pelvic tilt angle of the pin inserted into the pelvis under anesthesia was 15.8 degrees +/- 5.3 degrees (3 degrees -26 degrees) preoperatively and 12.1 degrees +/- 4.9 degrees (3 degrees -26 degrees) postoperatively. Mean flexion range of motion under anes-thesia was 109.4 degrees +/- 6.9 degrees (88 degrees -126 degrees) and that measured by a physical therapist was 101.1 degrees +/- 8.2 degrees (80 degrees -120 degrees); the difference was significant (9.7 degrees; p < 0.01).Interpretation: These results highlight the difficulty in accurately determining hip flexion angles without the use of special devices and may help surgeons and physical therapists recognize and address this issue.