The Orthobullets Podcast Recon | THA Acetabular Screw Fixation
Jan 18, 2026
Dive into the complexities of THA acetabular screw fixation! Learn about the quadrant method and how the posterior-superior zone is the prime target. Discover the dangers lurking in the posterior-inferior and anterior-superior zones, where risks to vital structures abound. The podcast unpacks high-hip anatomy shifts, surgical pitfalls, and real case studies highlighting screw placement complications. It's an enlightening exploration of safety zones and vascular threats that any orthopedics enthusiast won’t want to miss!
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Use The Quadrant System For Safe Screw Placement
- Draw two bisecting lines from the ASIS to the acetabular center and a perpendicular to divide four quadrants before screw placement.
- Target the posterior-superior quadrant for supplemental screws and avoid anterior-superior where external iliac vessels lie.
Beware Long Screws Posteriorly In Revisions
- Avoid placing long screws in the posterior-inferior quadrant beyond ~20 mm because they can endanger the sciatic and gluteal vessels and nerves.
- Recognize that in high-hip revisions the sciatic nerve may shift and become vulnerable in posterior-superior placements.
Evaluate For Iliopsoas And Bone-On Impingement
- Check for anterior iliopsoas impingement when the anterior rim of the cup sits proud using cross-table lateral radiographs or anesthetic injection.
- Be mindful that medializing or raising cup center reduces femoral offset and increases bone-on-impingement risk.