Modern Imaging in Planning a Personalized Hip Replacement and Evaluating the Spino-pelvic Relationship in Prosthetic Instability

Successful total hip arthroplasty (THA) greatly depends on appropriate implant choice and accurate femoral and acetabular component positioning. Preoperative radiographic templating is crucial, and accurate intraoperative execution of the templated plan is important to maximize implant stability and bearing performance. Traditionally, plain radiographs have been used for preoperative planning, as well as postoperative follow-up and assessment of component position, with historically defined “safe zones” for component position. However, as our understanding of optimal implant positioning in the setting of spino-pelvic dynamics has expanded, more advanced methods of radiographic assessment of implant positioning have gained popularity. Given the variations in anatomy and functional kinematics of a patient’s hip joint, the optimal THA component alignment and positioning may differ on a case by case basis, and therefore, advanced methods of assessing optimal patient-specific implant positioning are of prime importance.