Acetabular Management in Hip Hemiarthroplasty: Reaming Considerations and Current Evidence

Acetabular reaming during hip hemiarthroplasty is practiced inconsistently across surgeons and institutions, yet its benefits and risks remain uncertain. We reviewed the clinical and biomechanical literature addressing acetabular preparation in hemiarthroplasty, including evidence related to implant seating, acetabular wear, pain, function, and later conversion to total hip arthroplasty. Across the available studies, routine reaming did not demonstrate consistent improvement in patient-reported and radiographic outcomes and may compromise cartilage and bone preservation. The decision to ream should be individualized, reserving limited, targeted reaming for cases in which acetabular anatomy prevents stable seating, while prioritizing cartilage preservation in typical fracture patients.