Posterior Pelvic Tilt Allows for Increased Hip Motion, While Anterior Pelvic Tilt Decreases Joint Stress: A Systematic Review of Biomechanical and Motion Analyses
Authors: Kuhns BD, Kahana-Rojkind AH, Parsa A, McCarroll TR, Sikligar D, Domb BG
DOI: 10.1016/j.arthro.2025.02.021
Background
Pelvic tilt significantly influences hip joint biomechanics, impacting range of motion (ROM) and joint contact stresses. These effects are especially relevant in patients with femoroacetabular impingement (FAI) and acetabular dysplasia, conditions where joint mechanics determine treatment success.
Methods
Systematic review of 14 biomechanical and motion studies including 577 hips, assessing the effects of pelvic tilt on joint contact forces and hip ROM.
Key Findings
- Posterior pelvic tilt in dysplastic hips decreases femoral head coverage and joint contact area but increases joint contact pressure, potentially exacerbating cartilage stress.
- In FAI patients, posterior tilt enhances internal rotation and overall hip ROM, which may reduce mechanical impingement.
- Patients with FAI exhibit restricted posterior pelvic tilt during dynamic activities compared to controls.
- Anterior pelvic tilt is associated with decreased impingement-free hip motion, potentially limiting functional capacity.
Conclusion
Pelvic tilt should be carefully considered in clinical assessment, rehabilitation, and surgical planning. Posterior pelvic tilt can be beneficial in FAI by increasing hip ROM but may increase joint stress in dysplasia, suggesting individualized approaches.
What Does This Mean for Providers?
Providers should evaluate pelvic alignment as a modifiable factor influencing hip biomechanics. Therapeutic interventions or surgical strategies should consider how pelvic tilt impacts joint stress and motion to optimize patient outcomes, particularly when addressing FAI and acetabular dysplasia.