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. 2024 Sep;144(9):4405-4410.
doi: 10.1007/s00402-024-05540-x. Epub 2024 Sep 16.

Understanding pelvic mobility is important to correctly diagnose and treat painful hips with positive impingement test in non-arthritic patients

Wouter Peeters  1   2   3 , Martino Viganó  1   4 ; ReSurg; Nicolas Bonin  1
Collaborators, Affiliations

Understanding pelvic mobility is important to correctly diagnose and treat painful hips with positive impingement test in non-arthritic patients

Wouter Peeters et al. Arch Orthop Trauma Surg. 2024 Sep.

Abstract

Introduction: To determine repeatability of pelvic mobility, calculated as both change in sacral slope (∆SS) and pelvic tilt (∆PT), and evaluate their correlations with pelvic incidence (PI) in non-arthritic patients with hip pain and positive impingement test.

Methods: The cohort comprised 82 patients aged 31.8 ± 7.4, with hip pain and positive impingement test. Stereo-radiographic images were acquired in three positions (neutral standing, neutral sitting, and flexed-forward-sitting). PI, pelvic tilt (PT), and sacral slope (SS) were measured. Repeatability was evaluated. Pelvic mobility was calculated as ΔPT and ΔSS from (i) standing to sitting, (ii) neutral to flexed-forward-sitting, and (iii) maximum to minimum values. Correlations of PI with PT, SS, ΔPT, and ΔSS were assessed.

Results: Repeatability was excellent for all pelvic mobility measurements (intraclass correlation coefficients, ICC > 0.97). ΔPT was 25.9 ± 8.3º from standing to sitting, 14.4 ± 11.2º from standing to flexed-forward-sitting, and 37.8 ± 13.7º from maximum to minimum values. ΔSS was 24.0 ± 7.6º from standing to sitting, 14.2 ± 11.6º from standing to flexed-forward-sitting, and 35.9 ± 13.7º from maximum to minimum values. PI was strongly correlated with PT in standing (r = 0.7) and SS in standing (r = 0.7), and moderately correlated with PT in sitting (r = 0.6) and SS in sitting (r = 0.5), but was not correlated with neither ΔPT nor ΔSS (r < 0.3).

Conclusion: Pelvic mobility, calculated as ΔPT and ΔSS, has excellent repeatability, and is not correlated with PI in non-arthritic patients with hip pain. Therefore, PI is of limited value for diagnosis and treatment of painful hips with positive impingement test, as well as to distinguish hip users from spine users; pelvic mobility should be used instead.

Level of evidence: Level IV.

Keywords: Femoroacetabular impingement; Pelvic incidence; Pelvic mobility; Spino-pelvic parameters.

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Conflict of interest statement

Declarations Conflict of interest WP, MV, SRP, ED, and MS have nothing to declare. NB declares royalties and consultancy fees from Dedienne Santé, as well as royalties from ConMed. Ethical approval All patients provided informed consent for the use of their data for research and publications. The present work was completed after being approved by an institutional review board (IRB: COS-RGDS-2023–04-005-BONIN-N). Consent to participate Informed consent was obtained from all individual participants included in the study. Consent to publish Not applicable.

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