• Joost H J van Erp, Thom E Snijders, Harrie Weinans, René M Castelein, SchlösserTom P CTPCDepartment of Orthopedics, UMC Utrecht, Utrecht, The Netherlands., and Arthur de Gast.
• Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands. jverp@diakhuis.nl.
• Arch Orthop Trauma Surg. 2022 Jun 1; 142 (6): 1253-1264.

IntroductionDislocation remains a major complication in total hip arthroplasty (THA), in which femoral component orientation is considered a key parameter. New imaging modalities and definitions on femoral component orientation have been introduced, describing orientation in different planes. This study aims to systematically review the relevance of the different orientation parameters on implant stability.MethodsA systematic review was performed according to the PRISMA guidelines to identify articles in the PubMed and EMBASE databases that study the relation between any femoral component orientation parameters and implant stability in primary THA.ResultsAfter screening for inclusion and exclusion criteria and quality assessment, nine articles were included. Definitions to describe the femoral component orientation and methodologies to assess its relevance for implant stability differed greatly, with lack of consensus. Seven retrospective case-control studies reported on the relevance of the transversal plane orientation: Low femoral- or low combined femoral and acetabular anteversion was statistical significantly related with more posterior dislocations, and high femoral- or combined femoral and acetabular anteversion with anterior dislocations in two studies. There were insufficient data on sagittal and coronal component orientation in relation to implant stability.ConclusionBecause of incomparable definitions, limited quality and heterogeneity in methodology of the included studies, there is only weak evidence that the degree of transverse component version is related with implant stability in primary THA. Recommendations about the optimal orientation of the femoral component in all three anatomical planes cannot be provided. Future studies should uniformly define the three-dimensional orientation of the femoral component and systematically describe implant stability.© 2021. The Author(s).

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