The transverse acetabular ligament (TAL) is a reliable native anatomic landmark that can be used to guide accurate acetabular implant positioning during total hip arthroplasty through the direct anterior approach. The accurate acetabular implant position is defined by the preoperative plan, which corresponds to the Lewinnek safe zone. This article describes the anatomy of the TAL , exposure of the TAL, and pearls and pitfalls for exposure of the acetabulum during total hip arthroplasty through the direct anterior approach. This article discusses how the TAL is used to guide acetabular implant positioning and describes pilot data from our single surgeon case series (n = 31).
Patient EvaluationThe preoperative imaging workup includes AP standing and cross-table lateral radiographs of the hip. All patients with primary total hip arthroplasty (THA) are indicated for this technique. Identifying the transverse acetabular ligament (TAL) is challenging in cases of hypertrophic osteoarthritis; it can often be identified after osteophytes are taken down.
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