A Single-Reamer Technique is an Effective Strategy for Acetabular Preparation in Primary Total Hip Arthroplasty

Background

Effective acetabular preparation is a critical step of primary total hip arthroplasty (THA). Most techniques begin with a small reamer and subsequently utilize multiple larger reamers until the desired size is achieved. We reported the effectiveness of a more efficient, single-reamer technique by evaluating component success rates and determining its safety by reporting any intraoperative complications.

Methods

All primary, elective THAs performed through a direct anterior approach using fluoroscopic guidance by 2 fellowship-trained surgeons between October 2019 and May 2023 were retrospectively reviewed. Our inclusion criterion was use of a single-reamer technique and minimum 1-year follow-up. The single reamer was chosen as the largest one that fully seated in the native acetabulum without any anteroposterior translation between the walls.

Results

Data for 836 THAs were reviewed. Ninety-six hips (11%) with significant acetabular deformity where a single reamer technique could not be effectively used were excluded, leaving 740 (89%) that met the inclusion criteria. There were no intraoperative acetabular fractures. One (0.1%) cup was explanted during revision for periprosthetic joint infection. Of the 739 remaining cups, 25 (3%) required acetabular screws while 714 were placed without supplemental screw fixation. Overall, 99.7% of acetabular components implanted using a single-reamer technique achieved successful radiographic osseointegration at 1 year. One cup (0.1%) failed to achieve radiographic bony ingrowth yet has stable fibrous fixation that has not required revision.

Conclusions

When applied within a structured workflow to hips with normal acetabular morphology, a single-reamer technique is an effective and safe method for acetabular preparation.