http://www.bjj.boneandjoint.org.uk/content/96-B/3/312.abstract
http://www.ncbi.nlm.nih.gov/pubmed/24589784

The use of the transverse acetabular ligament for determining the orientation of the components in total hip replacement

a randomised controlled trial

1. W. J. Van Doorn, MD, Orthopaedic Surgeon2;
2. K. Koenraadt, MSc , Human Movement Scientist2; and
3. J. Kats, MD, Orthopaedic Surgeon2

+ Author Affiliations

1. 1Lievensberg Hospital, Boerhaaveplein 1, 4624 VT Bergen Op Zoom, the Netherlands.
2. 2Lievensberg Hospital, Bergen Op Zoom, the Netherlands.

1. Correspondence should be sent to Mr G Meermans; e-mail:geertmeermans@hotmail.com

Abstract

The orientation of the acetabular component can influence both the short- and long-term outcomes of total hip replacement (THR). We performed a prospective, randomised, controlled trial of two groups, comprising of 40 patients each, in order to compare freehand introduction of the component with introduction using the transverse acetabular ligament (TAL) as a reference for anteversion. Anteversion and inclination were measured on pelvic radiographs.

With respect to anteversion, in the freehand group 22.5% of the components were outside the safe zone versus 0% in the transverse acetabular ligament group (p = 0.002). The mean angle of anteversion in the freehand group was 21° (2° to 35°) which was significantly higher compared with 17° (2° to 25°) in the TAL group (p = 0.004). There was a significant difference comparing the variations of both groups (p = 0.008).

With respect to inclination, in the freehand group 37.5% of the components were outside the safe zone versus 20% in the TAL group (p = 0.14). There was no significant difference regarding the accuracy or variation of the angle of inclination when comparing the two groups.

The transverse acetabular ligament may be used to obtain the appropriate anteversion when introducing the acetabular component during THR, but not acetabular component inclination.

Cite this article: Bone Joint J 2014;96-B:312–18.

Footnotes

• The authors would like to thank I. Goetheer-Smits and H. Ooms for the assessment of the radiographs and their help with preparing the illustrations.
  No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
  This article was primary edited by J. Scott and first proof edited by D. Rowley.

• Received August 8, 2013.
• Accepted December 10, 2013.

• ©2014 The British Editorial Society of Bone & Joint Surgery