A Single-Reamer Technique is an Effective Strategy for Acetabular Preparation in Primary Total Hip Arthroplasty

Effective acetabular preparation is a critical step of primary total hip arthroplasty (THA). Most techniques begin with a small reamer and subsequently utilize multiple larger reamers until the desired size is achieved. We reported the effectiveness of a more efficient, single-reamer technique by evaluating component success rates and determining its safety by reporting any intraoperative complications.

All primary, elective THAs performed through a direct anterior approach using fluoroscopic guidance by 2 fellowship-trained surgeons between October 2019 and May 2023 were retrospectively reviewed. Our inclusion criterion was use of a single-reamer technique and minimum 1-year follow-up. The single reamer was chosen as the largest one that fully seated in the native acetabulum without any anteroposterior translation between the walls.

Data for 836 THAs were reviewed. Ninety-six hips (11%) with significant acetabular deformity where a single reamer technique could not be effectively used were excluded, leaving 740 (89%) that met the inclusion criteria. There were no intraoperative acetabular fractures. One (0.1%) cup was explanted during revision for periprosthetic joint infection. Of the 739 remaining cups, 25 (3%) required acetabular screws while 714 were placed without supplemental screw fixation. Overall, 99.7% of acetabular components implanted using a single-reamer technique achieved successful radiographic osseointegration at 1 year. One cup (0.1%) failed to achieve radiographic bony ingrowth yet has stable fibrous fixation that has not required revision.

When applied within a structured workflow to hips with normal acetabular morphology, a single-reamer technique is an effective and safe method for acetabular preparation.