Background <p>Total hip arthroplasty (THA) enhances quality of life by improving joint function. However, the success of this procedure heavily relies on precise acetabular cup positioning, which is insufficient using traditional placement guidelines, as evidenced by the persistent occurrence of dislocations. Therefore, enhancing pelvic alignment accuracy is crucial. Standard surgical tables present challenges in maintaining consistent pelvic positioning intraoperatively, making it difficult to achieve optimal alignment.</p> Purpose <p>This study evaluated the effectiveness of a traction surgical table in stabilizing pelvic movements during THA in comparison with a standard surgical table.</p> Methods <p>This retrospective observational study analyzed 88 consecutive THAs performed between December 2022 and March 2024 using the AR-HIP (Zimmer Biomet Japan, Tokyo, Japan) system for real-time pelvic navigation. Procedures were performed using either a standard (<i>n</i>=48) or a traction (<i>n</i>=40) surgical table. Pelvic alignment was monitored at multiple surgical stages, and stability was statistically analyzed to compare the efficacy of the two table types.</p> Results <p>The traction table significantly stabilized anteroposterior pelvic movements across all critical surgical stages (<i>p</i>&lt;0.05), except during anterior capsular release. In contrast, procedures performed on the standard table exhibited less stability in anteroposterior pelvic movements, suggesting superior performance of the traction table.</p> Conclusions <p>Compared with the standard table, the traction table in THA effectively controls anteroposterior pelvic movements, possibly facilitating more accurate acetabular cup orientation. However, lateral pelvic stability remains uncontrolled using both table types, indicating a need for further technological advancements in surgical practice to improve the outcomes of THA.</p>