Background: Pelvic tilt influences acetabular orientation (AO). Anatomical AO can be measured in relation to the anterior pelvic plane (APP), functional AO can be calculated relative to table's plane.
Objective: To assess to what extent functional AO is determined by pelvic tilt and if APP and table plane give equal information for correct AO.
Methods: AO was evaluated by computed tomography (CT) scans of 138 patients. Pelvic tilt, anatomical and functional AO were measured, differences between the two reference planes were calculated.
Results: Anatomical and functional acetabular anteversion (AA) were found to be different in 21% of individuals with an enhanced extent of pelvic tilt. Functional AA was increased compared to anatomical AA at high posterior pelvic tilt (p < 0.001). Enlarged anterior tilting of the pelvis reduced APP-related AA (p < 0.002). Anatomical AA positively correlated with pelvic tilt, particularly in females (p < 0.01, correlation coefficient = 0.698, R2 = 0.523).
Conclusions: APP and table plane do not provide equal information about AO at enhanced pelvic tilt. Functional orientation of the acetabulum is dependent on pelvic tilt, which itself is influenced by anatomical AA and should therefore be analyzed for precise AO.
Keywords: Acetabular orientation; functional anatomy; pelvic tilt; sagittal balance.