Spinopelvic Characteristics in Acetabular Retroversion: Does Pelvic Tilt Change After Periacetabular Osteotomy?

Background: Acetabular retroversion may lead to impingement and pain, which can be treated with an anteverting periacetabular osteotomy (aPAO). Pelvic tilt influences acetabular orientation; as pelvic tilt angle reduces, acetabular version reduces. Thus, acetabular retroversion may be a deformity secondary to abnormal pelvic tilt (functional retroversion) or an anatomic deformity of the acetabulum and the innominate bone (pelvic ring). Purpose: To (1) measure the spinopelvic morphology in patients with acetabular retroversion and (2) assess whether pelvic tilt changes after successful anteverting PAO (aPAO), thus testing whether preoperative pelvic tilt was compensatory. Study Design: Case series; Level of evidence, 4. Methods: A consecutive cohort of 48 hips (42 patients; 30 +/- 7 years [mean +/- SD]) with acetabular retroversion that underwent successful aPAO was studied. Spinopelvic morphology (pelvic tilt, pelvic incidence, anterior pelvic plane, and sacral slope) was measured from computed tomography scans including the sacral end plate in 21 patients, with adequate images. In addition, the change in pelvic tilt with aPAO was measured via the sacrofemoral-pubic angle with supine pelvic radiographs at an interval of 2.5 +/- 2 years. Results: The spinopelvic characteristics included a pelvic tilt of 4 degrees +/- 4 degrees, a sacral slope of 39 degrees +/- 9 degrees, an anterior pelvic plane angle of 11 degrees +/- 5 degrees, and a pelvic incidence of 42 degrees +/- 10 degrees. Preoperative pelvic tilt was 4 degrees +/- 4 degrees and did not change postoperatively (4 degrees +/- 4 degrees) (P = .676). Conclusion: Pelvic tilt in acetabular retroversion was within normal parameters, illustrating normal sagittal pelvic balance and values similar to those reported in the literature in healthy subjects. In addition, it did not change after aPAO. Thus, acetabular retroversion was not secondary to a maladaptive pelvic tilt (functional retroversion). Further work is required to assess whether retroversion is a reflection of a pelvic morphological abnormality rather than an isolated acetabular abnormality. Treatment of acetabular retroversion should focus on correcting the deformity rather than attempting to change the functional pelvic position.