We studied 105 patients who received a total hip arthroplasty between June 1985 and August 2001 using freehand positioning of the acetabular cup. Using pelvic CT scan and the hip-plan module of SurgiGATESystem (Medivision, Oberdorf, Switzerland), we measured the angles of inclination and anteversion of the cup. Mean inclination angle was 45.8°±10.1°(range: 23.0-71.5°) and mean anteversion angle was 27.3°±15.0°(range: −23.5°to 59.0°). We compared the results to the "safe" position as defined by Lewinnek et al. and found that only 27/105 cups were implanted within the limits of the safe position.We conclude that a safe position as defined by Lewinnek et al. [13] was only achieved in a minority of the cups that were implanted freehand.

Following open reduction and internal fixation of an ankle fracture, the correct position of the syndesmosis cannot be evaluated reliably with use of conventional radiographs or intraoperative fluoroscopy. In view of the high proportion of positive findings in this study, we believe that any treatment of a syndesmotic injury should include intraoperative three-dimensional imaging or at least a postoperative computed tomography scan.

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