The role of the transverse acetabular ligament in total hip arthroplasty.

We performed a systematic literature review to evaluate the role of the transverse acetabular ligament as a reference aid when determining acetabular component anteversion in total hip arthroplasty. We conducted a literature search in the MEDLINE, EMBASE and Pubmed databases using the key words 'transverse acetabular ligament' and 'arthroplasty'. Four studies published between 2006 and 2011, reporting on 1,217 procedures met our inclusion and exclusion criteria and were eligible for final evaluation. Outcome measures were the ability to identify the transverse acetabular ligament, anteversion of the acetabular component and dislocation rate. The methodological quality of the studies was variable and they were not homogenous enough for metaanalysis. We found that there was good evidence for the use of the transverse acetabular ligament in terms of accuracy of acetabular component anteversion. However, the ligament could not be routinely identified intra-operatively and other methods of determining the correct anteversion are recommended in this situation. The dislocation rate using this technique was low but it must be stressed that the cause of postoperative dislocation in total hip arthroplasty is multi-factorial and cannot solely be attributed to acetabular component orientation.