AbstractPelton turbines functioning in sandy river environments often encounter difficulties due to the swift movement of sediment particles, leading to erosion and damage to overflow components. These challenges can result in operational instability, particularly noticeable in large turbines. Pressure pulsation is crucial for turbine stability, and alterations in overflow component profiles caused by sediment erosion can worsen pressure pulsations. This study utilizes numerical simulations to analyze turbine pressure pulsations based on surface profile changes of runner buckets after 2 and 4 years of sediment erosion in a single 500 MW large‐scale Pelton turbine. Our findings reveal that erosion leads to a gradual decrease in pressure pulsation along the bucket's splitting edge from the notch to the root. After 4 years of erosion and wear, the relative pressure pulsation amplitude in the root region increased by more than 530%. Additionally, changes occur in the thickness of the water film in the erosion area on the working surface, disrupting the flow pattern and generating more vortices. This occurrence intensifies the relative pressure pulsation amplitude and reduces bucket stability. The study findings highlight the significant impact of sediment erosion on Pelton turbine pressure pulsation, posing a considerable risk to the unit's operational stability and safety.