Using intraoperative pelvic landmarks for acetabular component placement in total hip arthroplasty

Dislocation after total hip arthroplasty is frequently due to acetabular malpositioning. Positioning of the acetabular component using anatomical landmarks may reduce the incidence of dislocation from improper acetabular orientation. The pelvis provides 3 bony landmarks (ilium, superior pubic ramus, and superior acetabulum), which, when used to define a plane, allows cup orientation in abduction and version. Landmarks evaluated in 24 cadaveric acetabuli allowed slightly increased abduction and anteversion of the cup, compared with native acetabuli. Six hundred seventeen primary total hip arthroplasties were performed between 1996 and 2003 using this technique. Mean cup abduction was 44.4 degrees with 13.2 degrees of anteversion. This technique allows satisfactory reproducible cup orientation based on individual pelvic morphology. Review of patient outcome data suggest high patient satisfaction and lower dislocation rate without additional equipment, time, or cost.