Current Concepts in Acetabular Positioning in Total Hip Arthroplasty.

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering

Background:

• Total hip arthroplasty (THA) is increasingly performed in younger patients, raising expectations for long-term success.
• Acetabular cup positioning critically impacts THA outcomes, affecting dislocation, range of motion, wear, and implant longevity.

Purpose of the Study:

• To review current evidence on acetabular cup positioning in THA.
• To provide a systematic and pragmatic approach for achieving optimal cup placement.

Main Methods:

• Literature review synthesizing evidence on acetabular cup positioning variables.
• Analysis of the impact of depth, height, and angular position on THA results.
• Consideration of pelvic tilt and intraoperative positioning challenges.

Main Results:

• Anatomical positioning of the center of rotation offers advantages over medialization, including improved range of motion and bone stock preservation.
• Acetabular offset and height influence muscle function, limb length, and implant support.
• Achieving ideal angular position (anteversion and inclination) is challenging due to varied definitions and the influence of pelvic tilt.

Conclusions:

• Optimizing acetabular cup position requires careful consideration of depth, height, and angular orientation.
• Addressing pelvic tilt and standardizing positional definitions are essential for reproducible results.
• A systematic approach is needed to achieve the best individual acetabular cup position in total hip arthroplasty.