Soft-Tissue Balancing of the Hip

Inadequate soft-tissue balancing is a major yet often underemphasized cause of failure of primary and revision total hip arthroplasty1-3. Accordingly, contemporary cemented and cementless hip prostheses have been designed with consideration of this issue, and this has substantially increased the long-term survival of total hip replacements4. The primary objective of this article is to provide the reader with an overview of the rationale, biomechanical principles, and clinical implications associated with soft-tissue balancing of the hip. The final section will address several strategies to avoid inadequate soft-tissue balancing. In particular, a systematic technique to restore adequate soft-tissue tensioning during total hip arthroplasty will be presented.