Simplifying the Hip-Spine Relationship for Total Hip Arthroplasty: What Do I Need to Do Differently Intraoperatively?

As our recognition of the complexity of the hip-spine relationship is based on stability, there are several intraoperative strategies that surgeons may consider. First, patient positioning on the operative table plays an important role in reducing pelvic motion and tilt. Then, consider determining the femoral version before acetabular preparation and component insertion. The concept of a combined version of both components is an excellent guide to position. However, femoral version is often dictated by native femoral torsion, and therefore, it is the acetabular version that must be adjusted accordingly. Finally, based upon preoperative planning and intraoperative verification, the use of enabling technologies such as navigation, robotics, and other smart tools appears to play a major role of ever increasing importance in accurate component placement.