Electronic Letters to:

Hip: H. A. P. Archbold, B. Mockford, D. Molloy, J. McConway, L. Ogonda, and D. Beverland 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 Br 2006; 88-B: 883-886 [Abstract] [Full text] [PDF]

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The ideal version of the socket and transverse acetabular ligament ( TAL)

SHAHZAD SADIQ   (3 October 2006)

The transverse acetabular ligament

Hammad Malik   (7 August 2006)

The ideal version of the socket and transverse acetabular ligament ( TAL) 3 October 2006
SHAHZAD SADIQ, Orthopaedic Consultant (Locum) Royal Bolton Hospital Bolton Send letter to journal: Re: The ideal version of the socket and transverse acetabular ligament ( TAL) shahzad.sadiq1{at}btopenworld.com SHAHZAD SADIQ	Sir, I read this article with great interest. The transverse acetabular ligament as a pointer of acetabular version is a useful landmark. During positioning of the socket, many anecdotal surgical tips are used such as corner of the theatre room, acetabular guides, laser marker and computer assisted surgery. The ideal acetabular version for total hip replacement is still not defined. To some extent the acetabular socket position is chosen by the surgical approach used by the surgeon. The authors in this study quote a very low rate of dislocation using the posterior approach of only 0.6%, hence answering many criticisms of this approach. The dislocation rate however, is dependent on other technical variables such as capsular closure and repair of the short rotators, choosing the right femoral offset, acetabular version and inclination, adequate tissue tension and patient-related factors. It would be very interesting to review the correlation of TAL to radiological version of the sockets in this series and the correlation to the range of movement, in particular, flexion. S. Sadiq, Orthopaedic Consultant (Locum), Royal Bolton Hospital, Bolton, UK.
The transverse acetabular ligament 7 August 2006
Hammad Malik, Consultant Orthopaedic Surgeon/ Honorary Lecturer Arrowe Park Hospital and The University of Manchester Send letter to journal: Re: The transverse acetabular ligament hammy.malik{at}manchester.ac.uk Hammad Malik	Sir, I read the article by Archbold et al with great interest as it offers an easy and reproducible method of identifying the version of an individual's acetabulum. I notice that the number of patients with possibly distorted version of the acetabulum was very small (six with developmental dysplasia and 15 with post-traumatic arthritis). In such cases, use of the transverse ligament is probably not an accurate guide to the best position of the acetabular component. In addition, retroversion of the acetabulum in association with impingement is becoming an increasingly identified cause of osteoarthritis of the hip. Once again, in such cases, use of the transverse ligament as a guide to version could be misleading. It is important to consider all factors that may help in the correct insertion of components to decrease the incidence of dislocation and not solely rely on one landmark. H. Malik, Consultant Orthopaedic Surgeon/ Honorary Lecturer, Arrow Park Hospital and the University of Manchester, Manchester, UK.