Rear drop: a new radiographic landmark for estimation of pelvic tilt on pelvis AP radiographs

Estimation of pelvic tilt on anteroposterior (AP) pelvis radiograph is often done by indirect methods based on the midline pelvic landmarks. The purpose of this cadaveric study is to describe a new radiographic landmark and reference measurements to estimate the coronal tilt of the pelvis, independent of the midline references. The new radiologic reference is called 'rear drop', and its anatomic location is described with the cadaveric pelvis AP radiographs in various pelvic inclination. The parameters derived from the new reference were used to assess the pelvic tilt, and the results were compared with the previously established method using 'sacrococcygeal joint to symphysis distance' (SCSD). The shape of the new figure is used to determine the position of the pelvis, and its relationship with the previously described acetabular retroversion indicators was statistically analyzed. The new reference figure corresponds to the posteroinferior edge of the horseshoe shape of the acetabular margin. The newly derived reference parameters, rear to tear distance and rear to tear angle, changes with pelvic tilt and are strongly correlated with SCSD. The shape of the rear drop changes with the changing pelvic tilt and correlates statistically with the previously described acetabular retroversion indicators. Rear drop and its derivative measurements can be used as a reliable and reproducible indicator to estimate the coronal pelvic tilt, free of midline reference points. This new reference will be a base for future clinical studies on pelvic tilt, rotation and their application in intraoperative hip fluoroscopy.