1244 The TAL Suction Retractor: A Simple Technique for Visualising the Transverse Acetabular Ligament (TAL) During Total Hip Replacement (THR) Surgery

Introduction The transverse acetabular ligament (TAL) is an anatomical landmark that is of particular use during primary total hip replacements (THR). Visualisation is important to aid the orientation of the acetabular cup and it is a structure that can be identified in virtually every primary hip replacement surgery. We introduce a simple technique to facilitate this. Method A thoracic suction catheter is taped to the distal end of a blunt Hohmann’s retractor with two steristrips wrapping around the catheter and retractor leaving approximately 1-1.5cm of retractor exposed. Our preference is for a thoracic suction catheter with side holes and a proximal end which allows direct connection with the tip of the Yankauer suction. The blunt Hohmann’s retractor is used as the inferior acetabular retractor in the usual way, placed inferior to the transverse acetabular ligament, resting on the posterior ischial surface. The catheter suction tip should lie just under the TAL, in the most dependant point of the wound. Results The TAL suction catheter can be used continuously or intermittently to facilitate visualisation of the TAL during reaming, trialling, and acetabular cup placement. The TAL suction retractor provides suction in the most dependant point of the surgical wound, preventing unnecessary movement and facilitates a clutter-free surgical field leading to more streamlined and efficient surgery with potential reduced operative times. Conclusions The transverse acetabular ligament (TAL) suction retractor is a simple improvised surgical tool that makes it easier to visualise the TAL during acetabular preparation in total hip replacements.

The influence of sagittal pelvic malrotation on transverse acetabular ligament guided cup orientation: a retrospective cohort study

Background Total hip arthroplasty (THA) candidates frequently present pelvic malrotation. The aim of this study is to analyze how pelvic malrotation influence transverse acetabular ligament (TAL) guided cup orientation and investigate whether pelvic malrotation produce different clinical outcomes after THA. Methods We retrospectively reviewed a consecutive series of THA patients (144 hips) who use TAL as a guidance for cup positioning from March 2017 to January 2020. The patients were divided into normal pelvis (NP) group and backward pelvis (BP) group by sagittal pelvic malrotation assessed by APPA, the angle between the vertical and the APP on standing lateral pelvic radiographs preoperatively. Cup anteversion and inclination and that out of the safe zones were measured and compared in two groups. The demographic data, clinical results, and complications of patients were also compared. Results Backward pelvic malrotation were found in 60.6 % of this cohort of THA candidates. The mean angle of both inclination and anteversion in BP group were significantly larger than that in NP group. The rate of cup for anteversion and inclination above the safe zone in BP group was significantly larger than that in NP group. There were 4 patients in BP group recording anterior hip dislocation after surgery. Other complications were not observed at last follow-up. Conclusions Backward pelvis malrotation may increase TAL guided cup inclination and anteversion, which were inclined to became outlier above the safe zone. This likely increase the rates of dislocation after THA. For the patients with pelvis malrotation, cup positioning should be performed individually instead of guided by TAL.