Technical pearls in total hip arthroplasty

Total hip arthroplasty (THA) has had a big impact on the quality of life of millions of patients. Primary THA has a very high success rate and implant survival time of more than 30 years have been reported. However, because of the high number of procedures performed, the small percentage of patients requiring a revision surgery still represent a large number of patients. Templating by means of radiography of hip joints with a defectuous implant-bone fixation can be hindered by the presence of cement and/or by reduced bone quality. Selection of the implant should be guided by the altered anatomy of the femur and/or acetabulum. In some cases the commercially available implants do not allow fixation and restoration of the joint mechanics. To adapt the implants to the patient's anatomy custom production can be envisioned. Custom made stem implants have been used since 1987 in our centre. Adaptations have been made and tests for evaluating implant stability have been evaluated. Also a new technique that has the objective to help the surgeon in determing the correct stem insertion during surgery has shown promissing results. Several changes in design of the acetabular component have progressively improved the cup stability, even in revision surgery. But a small number of patients present with pelvic and acetabular bone defects that cannot be bridged by the standard cup implants. Also custom made acetabular implants are progressively been used and the new production techniques offer promissing perspectives.