To investigate whether anterior pelvic plane-pelvic tilt (APP-PT) is associated with distinct hip pathomorphologies, we asked: (1) Is there a difference in APP-PT between symptomatic young patients eligible for joint preservation surgery and an asymptomatic control group? (2) Does APP-PT vary between distinct acetabular and femoral pathomorphologies? (3) Does APP-PT differ in symptomatic hips based on demographic factors?

IRB-approved, single-center, retrospective, case-control, comparative study in 388 symptomatic hips (357) patients (mean age 26 ± 2 years [range 23 to 29], 50% females) that presented to our tertiary center for joint preservation over a five year-period. Patients were allocated to 12 different morphologic subgroups. The overall study group was compared to a control group of 20 asymptomatic hips (20 patients). APP-PT was assessed in all patients based on AP pelvis X-rays using the validated HipRecon software. Values between overall and control group were compared using an independent samples t-test. Multiple regression analysis was performed to examine the influences of diagnoses and demographic factors on APP-PT. Minimal clinically important difference (MCID) of APP-PT was defined as >1 standard deviation.

No significant differences in APP-PT between the control group and overall group (1.1 ± 3.0° [−4.9 to 5.9] vs 1.8 ± 3.4° [−6.9 to 13.2], p = 0.323) were observed. Acetabular retroversion and overcoverage groups showed higher APP-PT compared to the control group (both p < 0.05) and were the only diagnoses with significant influence on APP-PT in the stepwise multiple regression analysis. However, all observed differences were below the MCID. Demographic factors age, gender, height, weight and BMI showed no influence on APP-PT.

APP-PT across different hip pathomorphologies showed no clinically significant variation. It does not appear to be a relevant contributing factor in the evaluation of young patients eligible for hip preservation surgery.