Implanting the acetabular cup of hard-on-hard bearings, like metal-on-metal or ceramic-on-ceramic, requires considerable surgeon skill to avoid the complications associated with edge loading. Successful cup positioning instruments have been designed in the past by pioneering surgeons, like Peter Ring and Michael Freeman, and these are re-visited in this article. An advantage of these instruments is that they could position the acetabular cup without defining a reference pelvic plane. Computer-assisted cup orientation is able to reduce outliers in cup orientation, but the technology has not been widely adopted. There may be an opportunity to improve the uptake of computer-assisted surgery by incorporating some of the concepts from historically successful manual instruments.
National Joint Registry for England and Wales 8th Annual Report2011, www.njrcentre.co.uk (accessed November 2011).
2.
New Zealand Orthopaedic Association. New Zealand Joint Registry Eleven Year ReportJanuary1999–December2009, http://www.cdhb.govt.nz/njr/ (accessed March 2011).
3.
CarringtonNCSierraRJGieGA. The Exeter Universal cemented femoral component at 15 to 17 years an update on the first 325 hips. J Bone Joint Surg Br2009; 91B(6): 730–737.
4.
WroblewskiBMPurbachBSineyPD. Charnley low-friction arthroplasty in teenage patients the ultimate challenge. J Bone Joint Surg Br2010; 92B(4): 486–488.
5.
ChevillotteCPibarotVCarretJ-P. Nine years follow up of 100 ceramic on ceramic total hip arthroplasty. Int Orthop2011; 35(11): 1599–1604.
6.
KimYHChoiYKimJS. Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis. Int Orthop2010; 34(8): 1123–1127.
7.
BoyerPHutenDLoriautP. Is alumina-on-alumina ceramic bearings total hip replacement the right choice in patients younger than 50 years of age? A 7- to 15-year follow-up study. Orthop Traumatol Surg Res2010; 96(6): 616–622.
8.
MurphySBEckerTMTannastM. Two- to 9-year clinical results of alumina ceramic-on-ceramic THA. Clin Orthop Relat Res2006; 453: 97–102.
9.
HuoMHMartinRPZatorskiLE. Cementless total hip arthroplasties using ceramic-on-ceramic articulation in young patients. A minimum 5-year follow-up study. J Arthroplasty1996; 11(6): 673–678.
10.
HamiltonWGMcAuleyJPDennisDA. THA with Delta ceramic on ceramic: results of a multicenter investigational device exemption trial. Clin Orthop Relat Res2010; 468(2): 358–366.
11.
DorrLDWangZILongjohnDB. Total hip arthroplasty with use of the metasul metal-on-metal articulation – four to seven-year results. J Bone Joint Surg Am2000; 82A(6): 789–798.
12.
SieberHPRiekerCBKottigP. Analysis of 118 second-generation metal-on-metal retrieved hip implants. J Bone Joint Surg Br1999; 81B(1): 46–50.
13.
Australian Orthopaedic Association National Joint Replacement Registry Annual Report2011, www.dmac.adelaide.edu.au/aoanjrr (accessed 21 October 2011).
14.
SwansonTVPetersonDJSeethalaR. Influence of prosthetic design on squeaking after ceramic-on-ceramic total hip arthroplasty. J Arthroplasty2010; 25(6 Sup): 36–42.
15.
CurrierJHAndersonDEVan CittersDW. A proposed mechanism for squeaking of ceramic-on-ceramic hips. Wear2010; 269(11–12): 782–789.
16.
RestrepoCPostZDKaiB. The effect of stem design on the prevalence of squeaking following ceramic-on-ceramic bearing total hip arthroplasty. J Bone Joint Surg Am2010; 92(3): 550–557.
17.
SarialiEStewartTJinZM. In vitro investigation of friction under edge loading conditions for ceramic-on-ceramic total hip prosthesis. J Orthop Res2010; 28(8): 979–985.
18.
WalterWLInsleyGMWalterWK. Edge loading in third generation alumina ceramic-on-ceramic bearings: stripe wear. J Arthroplasty2004; 19(4): 402–413.
19.
WalterWLYeungEEspositoC. A review of squeaking hips. J Am Acad Orthop Surg2010; 18(6): 319–326.
20.
LangtonDJJoyceTJJamesonSS. Adverse reaction to metal debris following hip resurfacing the influence of component type, orientation and volumetric wear. J Bone Joint Surg Br2011; 93B(2): 164–171.
21.
De HaanRCampbellPASuEP. Revision of metal-on-metal resurfacing arthroplasty of the hip: the influence of malpositioning of the components. J Bone Joint Surg Br2008; 90(9): 1158–1163.
22.
PanditHGlyn-JonesSMcLardy-SmithP. Pseudotumours associated with metal-onmetal hip resurfacings. J Bone Joint Surg Br2008; 90B(7): 847–851.
23.
BowsherJGNevelosJWilliamsPA. ‘Severe’ wear challenge to ‘as-cast’ and ‘double heat-treated’ large-diameter metal-on-metal hip bearings. Proc IMechE, Part H: J Engineering in Medicine2006; 220(H2): 135–143.
24.
KamaliAHussainALiC. Tribological performance of various CoCr microstructures in metal-on-metal bearings the development of a more physiological protocol in vitro. J Bone Joint Surg Br2010; 92B(5): 717–725.
25.
FisherJJinZTipperJ. Tribology of alternative bearings. Clin Orthop Relat Res2006; 453: 25–34.
26.
TukeMAScottGRoquesA. Design considerations and life prediction of metal-on-metal bearings: the effect of clearance. J Bone Joint Surg Am2008; 90(Sup 3): 131–141.
27.
UnderwoodRMatthiesACannP. A comparison of explanted articular surface replacement and birmingham hip resurfacing components. J Bone Joint Surg Br2011; 93-B(9): 1169–1177.
28.
MatthiesAUnderwoodRCannP. Retrieval analysis of 240 metal-on-metal hip components, comparing modular total hip replacement with hip resurfacing. J Bone Joint Surg Br2011; 93-B(3): 307–314.
29.
LangtonDJJamesonSSJoyceTJ. The effect of component size and orientation on the concentrations of metal ions after resurfacing arthroplasty of the hip. J Bone Joint Surg Br2008; 90-B(9): 1143–1151.
30.
De HaanRPattynCGillHS. Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br2008; 90-B(10): 1291–1297.
31.
ShimminAJWalterWLEspositoC. The influence of the size of the component on the outcome of resurfacing arthroplasty of the hip a review of the literature. J Bone Joint Surg Br2010; 92B(4): 469–476.
32.
BeckmannJLuringCTingartM. Cup positioning in THA: current status and pitfalls. A systematic evaluation of the literature. Arch Orthop Trauma Surg2009; 129(7): 863–872.
33.
ArchboldHAPMockfordBMolloyD. The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement – a preliminary study of 1000 cases investigating postoperative stability. J Bone Joint Surg Br2006; 88B(7): 883–886.
34.
SotereanosNGMillerMCSmithB. Using intraoperative pelvic landmarks for acetabular component placement in total hip arthroplasty. J Arthrop2006; 21(6): 832–840.
35.
HartAJIloKUnderwoodR. The relationship between the angle of version and rate of wear of retrieved metal-on-metal resurfacings a prospective, CT-based study. J Bone Joint Surg Br2011; 93B(3): 315–320.
36.
DoyleJMurrayPMahonyPO. Acetabular cup-siting device for total hip-arthroplasty. Arch Orthop Trauma Surg1989; 108(5): 317–321.
37.
EcheverriSLeyvrazPFZambelliPY. Reliable acetabular cup orientation with a new gravity-assisted guidance system. J Arthroplasty2006; 21(3): 413–419.
38.
ParratteSKilianPPaulyV. The use of ultrasound in acquisition of the anterior pelvic plane in computer-assisted total hip replacement. J Bone Joint Surg Br2008; 90B(2): 258–263.
39.
JeffersJRTWilliamsPTaylorA. Laser guided instrumentation for optimum acetabular cup orientation in hip replacement. In: Transactions of the 55th meeting of the Orthopaedic Research Society, 22–25 February 2012, Las Vegas, Rosemont, IL: Orthopaedic Research Society.
40.
RingPA. Complete replacement arthroplasty of the hip by the ring prosthesis. J Bone Joint Surg Br1968; 50-B(4): 720–731.
41.
ZhangYZLuSYangY. Design and primary application of computer-assisted, patient-specific navigational templates in metal-on-metal hip resurfacing arthroplasty. J Arthroplasty2011; 26(7): 1083–1087.
42.
DiGioiaAMJaramazBBlackwellM. Image guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop Rel Res1998; 355: 8–22.
43.
ParratteSArgensonJ-NA. Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty – a prospective, randomized, controlled study. J Bone Joint Surg Am2007; 89A(3): 494–499.
44.
BeckmannJStengelDTingartM. Navigated cup implantation in hip arthroplasty a meta-analysis. Acta Orthop2009; 80(5): 538–544.
45.
DaviesBLBaenaFMRyBarrettARW. Robotic control in knee joint replacement surgery. Proc IMechE, Part H: J Engineering in Medicine2007; 221(H1): 71–80.
46.
DavdaKMasjediMHartAJ. The accuracy of CT based navigation versus freehand hip resurfacing: an analysis of acetabular component orientation. In: Proceedings of the 11th annual meeting of the International Society for Computer Assisted Orthopaedic Surgery, London, 2011.
47.
LangJEMannavaSFloydAJ. Robotic systems in orthopaedic surgery. J Bone Joint Surg Br2011; 93(10): 1296–1299.
48.
BellemansJ. Navigation and CAS: is D-Day approaching?Knee Surg Sports Traumatology Arthroscopy2009; 17(10): 1141–1142.
49.
AnderstWZauelRBishopJ. Validation of three-dimensional model-based tibio-femoral tracking during running. Med Engng Physics2009; 31(1): 10–16.
