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The transverse acetabular ligament: optimizing version
1The Primary Joint Unit, Musgrave Park Hospital, Belfast, United Kingdom. david.beverland@belfasttrust.hscni.net
Orthopedics
|September 16, 2010
Summary
The transverse acetabular ligament aids in achieving optimal acetabular version during total hip arthroplasty, significantly reducing dislocation rates. This anatomical landmark provides a reliable method for cup positioning, improving patient outcomes.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Anatomy
Background:
- Excessive acetabular version in total hip arthroplasty (THA) is linked to instability and pain.
- Current methods for determining acetabular version can be imprecise, leading to suboptimal outcomes.
Purpose of the Study:
- To investigate the transverse acetabular ligament (TAL) as a reliable landmark for defining normal acetabular version in THA.
- To evaluate the impact of using the TAL on reducing dislocation rates.
Main Methods:
- Analysis of 1000 consecutive THA cases to grade the visibility and accessibility of the TAL.
- Intraoperative assessment and utilization of the TAL for acetabular component positioning.
- Comparison of dislocation rates before and after implementing the TAL as a positioning guide.
Main Results:
- The TAL was used to reduce the primary dislocation rate from 3.7% to 1%.
- The TAL was visible in 49% of cases, with the remainder requiring dissection or reaming.
- Individualized cup versioning and surgeon independence from estimating angles were noted advantages.
Conclusions:
- The transverse acetabular ligament is a valuable, consistently present landmark for achieving correct acetabular version in THA.
- Utilizing the TAL can significantly decrease dislocation rates, particularly with posterior approaches.
- While beneficial for version, the TAL does not guide inclination; 35° is recommended for the posterior approach.
