IMPLICATIONS OF PELVIC TILT IN KNEE ARTHROPLASTY: A NARRATIVE REVIEW

¹ Reconstructive Orthopaedic Surgery Innovative Techniques, Musculoskeletal Tissue Bank, IRCCS Orthopedic Institute Rizzoli, Bologna, Italy
² Reconstructive Orthopaedic Surgery Innovative Techniques – Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
³ Spine Surgery Unit, IRCSS Orthopedic Institute Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
⁴ Spine Surgery Unit, IRCSS Orthopedic Institute Rizzoli, Bologna, Italy
⁵ Bentivoglio Orthopaedic Unit, IRCCS Orthopedic Institute Rizzoli, Bologna, Italy
⁶ Nursing, Technical and Rehabilitation Assistance Service, IRCCS Orthopedic Institute Rizzoli, Bologna, Italy
⁷ Vita-Salute San Raffaele University, Orthopedics and Traumatology Department, Milan, Italy

Correspondence to:

European Journal of Musculoskeletal Diseases 2026 May-August 15(2): 111-119
https://doi.org/10.82093/ejmd/2026v15iss2_6

Received: 18 March 2026 Accepted: 21 April 2026

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Abstract

Pelvic tilt (PT), defined as the orientation of the pelvis relative to the sagittal and frontal planes, plays a significant role in the biomechanics of the lower limb and thus impacts the outcomes of knee arthroplasty. This expert review explores the clinical and biomechanical effects of anterior, posterior, and lateral PT, examining how these postural deviations influence prosthetic joint balancing, alignment, and postoperative recovery. We also discuss current limitations in evaluating and managing pelvic tilt during knee replacement surgery, highlighting the need for an integrated multidisciplinary approach to optimize clinical outcomes.

Keywords: alignment, biomechanics, joint balancing, knee arthroplasty, pelvic tilt