18 - Component Positioning and Stable Fixation in Total Hip Arthroplasty

Abstract

Total hip arthroplasty is a successful and cost-effective surgical treatment with the main goal of providing patients with an enduring, painless, and stable joint. In order to achieve such results, proper positioning and fixation of the femoral and acetabular components is essential. Preoperative templating helps to establish a preliminary plan for component positioning and assists in identifying any potential challenges or complications that may be identified intraoperatively. Patient-specific factors such as dysplasia, bone loss, and spinopelvic tilt should be taken into account when formulating a preoperative plan. A thorough knowledge and understanding of the available cementless and cemented femoral and acetabular component options helps to ensure that the best combination is utilized in each case. Intraoperatively, proper femoral and acetabular component positioning and fixation are essential for a desirable outcome. Each component should be placed within the defined parameters in all planes. Familiarity with anatomic landmarks and available surgical guides can assist in achieving this outcome. Hip stability and leg length are important factors to be monitored and tested intraoperatively when determining final component positioning. If the desired press-fit is not able to be obtained during final component placement, the surgeon should troubleshoot the situation in a stepwise fashion and determine whether adjunct fixation will be necessary. Postoperatively, leg length discrepancy is a common complaint that should be monitored for the initial period prior to any nonoperative or operative intervention. Radiographs should be regularly obtained to monitor for signs of component migration into a position of potential instability or failure.