Anatomical alignment of the acetabular component using transverse acetabular ligament in total hip replacement: a prospective cohort study

TL;DR

This study shows that the transverse acetabular ligament can guide proper placement of hip implants, improving surgical results.

Contribution

The study demonstrates the TAL as a reliable anatomical landmark for acetabular cup alignment in hip replacement surgery.

Findings

TAL orientation correlates significantly with acetabular alignment in imaging and intraoperative measurements.

TAL anteversion and inclination values are consistent across CT, MRI, and surgery.

Using TAL improves patient-specific acetabular cup positioning within the safe zone.

Abstract

Optimal positioning of the acetabular component is crucial in total hip replacement surgery to minimize postoperative dislocation rates. The transverse acetabular ligament (TAL) has been proposed as a useful anatomical landmark for cup orientation. This prospective cohort study included 122 patients who underwent total hip replacement at E Hospital, Hanoi, between January 2021 and December 2022. Orientation angles of the TAL and acetabulum were assessed preoperatively using CT with multiplanar reconstruction and MRI arthrography, and intraoperatively with a handmade protractor developed at our institution. The mean anteversion of TAL on CT and MRI was approximately 10°, with a mean inclination of 45–46°. Intraoperatively, the mean TAL anteversion was 10.2° and the acetabular anteversion was 12.0°, while the mean TAL inclination was 44.9° and the acetabular inclination 41.9°. These findings demonstrate significant correlations between TAL orientation and acetabular alignment across imaging and intraoperative measurements. TAL is a readily identifiable landmark, and its use can facilitate accurate, patient-specific acetabular cup positioning within the safe zone, thereby enhancing surgical outcomes.

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