Open Access
Review
Table 3
Tips and tricks for posterior approach.
| Soft tissue management | • We encourage a minimally-invasive approach with preservation of piriformis tendon. |
| • No specific recommendations for closing and reconstructing of the joint capsule and external rotator muscles. | |
| • Keep the transverse acetabular ligament intact to determine the acetabulum version. | |
| Acetabulum preparation | • Requires a good acetabular exposure. |
| • Start by reaming vertically with a small diameter reamer in order to remove all the osteophytes around the acetabular fossae. | |
| • The inferior edge of the reamer is then placed in line with the transverse acetabular ligament to respect anatomic anteversion. | |
| • Try to use smallest cup size that will allow a good primary fixation. | |
| Cup positioning | • Keep a sufficient anteversion to avoid psoas impingement and decrease the risk of dislocation. |
| • A supero-posterior bone coverage defect of the cup is often observed and has no consequences. | |
| Intraoperative testing | • For stability tests, the hip is flexed at 90° and an internal rotation is gradually applied. If dislocation occurs at more than 45°, the THA is considered stable. |
| • For length and femoral offset parameters, the piston sign observed with knee fully extended has to disappear when the knee is flexed at 90° of flexion. |
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