Pelvic tilt and movement during total hip arthroplasty in the lateral decubitus position

Objectives: Total hip arthroplasty (THA) is often performed in the lateral decubitus (lateral) position. In this position, the pelvis may have various degrees of tilt leading to implant malposition. We sought to quantify the pelvic tilt in lateral position and further pelvic movement during surgery. Methods: In 95 cases with primary THA, three-dimensional pelvic tilts were quantified by superimposing images reconstructed from CT data onto antero-posterior radiographs taken in lateral position at set-up and after cup placement. Pelvises were fixed with a device compressing anterior superior iliac spines and sacrum. Results: Various degrees of pelvic tilt occurred compared to the supine position; sagittal: -3.1 degrees (-25.5 degrees to 10.2 degrees), axial: 3.9 degrees (-8.4 degrees to 17 degrees), coronal: 0.9 degrees (-11.9 degrees to 13.2 degrees). Absolute changes more than 5 degrees were observed 43%, 47%, and 12% in the sagittal, axial, and coronal planes, respectively. The more preoperative posterior pelvic tilt resulted in the more change in the sagittal plane. Further pelvic movement of about 3 degrees in three planes were observed ranging from -11 degrees to 20 degrees after cup placement. Conclusion: This study showed various pelvic tilt and movement during THA. As pelvic tilt directly alters the cup orientation, its changes should be well understood. Improved tools for positioning and holding the pelvis are required.