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Preoperative planning is mandatory to achieve the restoration of a correct and personalized biomechanics of the hip.
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The radiographic review is the first and fundamental step in the planning. Limb or pelvis malpositioning during the review results in mislead planning.
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Correct templating is possible using three different methods: acetate templating on digital X-ray, digital 2D templating on digital X-ray and 3D digital templating on CT scan.
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Time efficiency, costs, reproducibility and accuracy must be considered when comparing different templating methods. Based on these parameters, acetate templating should not be abandoned; digital templating allows a permanent record of planning and can be electronically viewed by different members of surgical team; 3D templating is intrinsically more accurate. There is no evidence in the few recently published studies that 3D templating impacts positively on clinical outcomes except in difficult cases.
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The transverse acetabular ligament (TAL) is a reliable intraoperative soft tissue reference to set cup position.
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Spine–hip relations in osteoarthritic patients undergoing hip joint replacement must be considered.
Cite this article: EFORT Open Rev 2019;4:626-632. DOI: 10.1302/2058-5241.4.180075
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Hip, spine, and pelvis move in coordination with one another during activity, forming the lumbopelvic complex (LPC).
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These movements are characterized by the spinopelvic parameters sacral slope, pelvic tilt, and pelvic incidence, which define a patient’s morphotype.
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LPC kinematics may be classified by various systems, the most comprehensive of which is the Bordeaux Classification.
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Hip–spine relationships in total hip arthroplasty (THA) may influence impingement, dislocation, and edge loading.
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Historical ‘safe zones’ may not apply to patients with impaired spinopelvic mobility; adjustment of cup inclination and version and stem version may be necessary to achieve functional orientation and avert complications.
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Stem design, bearing surface (including dual mobility), and head size are part of the armamentarium to treat abnormal hip–spine relationships.
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Special attention should be directed to patients with adult spine deformity or fused spine because they are at increased risk of complications after THA.
