Preoperative planning is mandatory to achieve the restoration of a correct and personalized biomechanics of the hip.
The radiographic review is the first and fundamental step in the planning. Limb or pelvis malpositioning during the review results in mislead planning.
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.
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.
The transverse acetabular ligament (TAL) is a reliable intraoperative soft tissue reference to set cup position.
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
Giuseppe SolarinoDepartment of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, School of Medicine, University of Bari Aldo Moro, AOU Consorziale ‘Policlinico’, Bari, Italy
Hip, spine, and pelvis move in coordination with one another during activity, forming the lumbopelvic complex (LPC).
These movements are characterized by the spinopelvic parameters sacral slope, pelvic tilt, and pelvic incidence, which define a patient’s morphotype.
LPC kinematics may be classified by various systems, the most comprehensive of which is the Bordeaux Classification.
Hip–spine relationships in total hip arthroplasty (THA) may influence impingement, dislocation, and edge loading.
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.
Stem design, bearing surface (including dual mobility), and head size are part of the armamentarium to treat abnormal hip–spine relationships.
Special attention should be directed to patients with adult spine deformity or fused spine because they are at increased risk of complications after THA.