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Review
. 2023 Dec 1;5(1):59.
doi: 10.1186/s42836-023-00213-3.

Acetabular cup positioning in primary routine total hip arthroplasty-a review of current concepts and technologies

Aravind Sai Sathikumar  1 , George Jacob  2 , Appu Benny Thomas  2 , Jacob Varghese  2 , Venugopal Menon  3
Affiliations
Review

Acetabular cup positioning in primary routine total hip arthroplasty-a review of current concepts and technologies

Aravind Sai Sathikumar et al. Arthroplasty. .

Abstract

Introduction: Total hip arthroplasty (THA) has revolutionized the treatment of hip joint arthritis. With the increased popularity and success of the procedure, research has focused on improving implant survival and reducing surgical complications. Optimal component orientation has been a constant focus with various philosophies proposed. Regardless of the philosophy, achieving an accurate acetabular position for each clinical scenario is crucial. In this paper, we review the recent developments in improving the accuracy and ideal positioning of the acetabular cup in routine primary THA.

Methodology: A review of the recent scientific literature for acetabular cup placement in primary THA was performed, with available evidence for safe zones, spinopelvic relationship, preoperative planning, patient-specific instrumentation, navigation THA and robotic THA.

Conclusion: Though the applicability of Lewinnek safe zones has been questioned with an improved understanding of spinopelvic relationships, its role remains in positioning the acetabular cup in a patient with normal spinopelvic alignment and mobility. Evaluation of spinopelvic relationships and accordingly adjusting acetabular anteversion and inclination can significantly reduce the incidence of dislocation in patients with a rigid spine. In using preoperative radiography, the acetabular inclination, anteversion and intraoperative pelvic position should be evaluated. With improving technology and the advent of artificial intelligence, superior and more accurate preoperative planning is possible. Patient-specific instrumentation, navigated and robotic THA have been reported to improve accuracy in acetabular cup positioning as decided preoperatively but any significant clinical advantage over conventional THA is yet to be elucidated.

Keywords: Acetabular cup positioning; Navigation THA; Patient specific instrumentation; Primary THA; Robotic THA; Spinopelvic relation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Lumbosacral spine with pelvis lateral view showing normal spine with normal mobility (1A). a Pelvic tilt (APP = 13°), PI-LL (48.3°–53.1° = -4.8°). b, c ^SS > 10°
Fig. 2
Fig. 2
Lumbosacral spine with pelvis lateral view showing a normal spine with reduced mobility (1B). a PI–LL (55.5°–64.8° = -9.3°). b, c ^SS < 10°
Fig. 3
Fig. 3
Lumbosacral spine with pelvis lateral view indicating a flatback with normal mobility (2A). a PI-LL (46.6°–62.7° = -16°). b, c ^SS > 10°
Fig. 4
Fig. 4
Lumbosacral spine with pelvis lateral view showing a flatback with reduced mobility (2B). a PI-LL (57.5°–28.5° = 29°). b, c ^SS < 10°
Fig. 5
Fig. 5
Standing AP view of pelvis with both hips. (Right)—A patient with normal lordosis and mobile spine. (Left)—A patient with flat back deformity and immobile spine
Fig. 6
Fig. 6
Pelvis with both hips AP view with the patient lying in lateral position to evaluate the position of the pelvis at the time of surgery—a No coronal plane deformity, iliac crest at the same level indicating pelvis is perpendicular to the horizontal plane; b Hip abduction deformity showing iliac crest at different levels hence pelvis is tilted in lateral position
See this image and copyright information in PMC

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