Acetabular Reaming: Routines or Convictions?

Background: Total hip arthroplasty (THA) rates continue to rise globally, necessitating precise surgical techniques to optimize long-term outcomes. Acetabular reaming is a critical step in THA, as it dictates component positioning, restoration of the hip's center of rotation, and the stability of cementless press-fit fixation. However, variability in reamer design, manufacturing tolerances, and the effects of instrument wear present challenges to achieving anatomical reconstruction.

Objective: This study evaluates the technical determinants of acetabular reaming, assesses current surgical practices among French orthopedic surgeons, and examines the clinical and logistical implications of utilizing single-use reaming instruments.

Key Points: Anatomical studies indicate that the acetabulum is subhemispherical and elliptical, requiring reaming that respects the articular area while avoiding excessive medialization into the acetabular fossa. Sequential reaming often leads to distal and medial displacement of the center of rotation. A survey of 102 surgeons revealed that 74.5% utilize sequential reaming, despite risks of bone stock depletion. Biomechanical data suggest that used reamers are less efficient, generate potentially osteonecrotic heat, and produce smaller-than-nominal diameters. Single-use reamers offer a high-performance alternative, ensuring consistent sharpness and precision while simplifying decontamination protocols and reducing the institutional carbon footprint.

Conclusion: Optimal acetabular preparation requires 3D planning and anatomical reaming that preserves the quadrilateral lamina. The adoption of single-use reamers may improve the reproducibility of cup positioning and primary fixation stability by eliminating the variables associated with instrument degradation and sterilization cycles.