A novel technique for centering the femoral stem in primary total hip arthroplasty

Careful surgical technique is a critical component of total hip arthroplasty. Femoral preparation and component positioning are vital to improving outcomes and preventing complications. Using the starting awl when preparing the femur aids in opening and centralizing the canal for sequential reaming or broaching. Although traditional techniques can lead to a deviation from midline, a novel technique allows the awl to center itself in the canal with little risk for cortical perforation. We evaluated 200 patients whose surgeries were performed by a single surgeon using the traditional technique (group 1) or a novel technique (group 2) and found a statistically significant difference in mean deviation from midline. In group 2, the mean deviation was 0.34°; in group 1, the mean deviation was 0.85°. Our novel technique provides a safe, easily reproducible approach to using the starter awl in femoral preparation.