Objective To explore the method of accurately estimating the acetabular cup prosthesis coverage rate (hereinafter referred to as “cup coverage rate”) in total hip arthroplasty (THA) based on X-ray films, and to determine the effective parameters that can be used to estimate the cup coverage rate. MethodsThe three-dimensional printed pelvic models were established based on CT data of 16 healthy pelvis, and the acetabular prosthesis were implanted according to conventional THA procedure. The length and width of the uncovered area of the acetabular cup prosthesis were measured by a modified X-ray recording method with a rotating C-arm X-ray machine, and the cup coverage rate was calculated. Then the differences among the traditional anteroposterior X-ray recording method, the modified method, and actual measurement on pelvic model were statistically analyzed. The correlation between the area of the uncovered area of the prosthesis and its width and length was analyzed by using multiple linear regression analysis. Results The cup coverage rates of traditional method, modified method, and actual measurement were 78.22%±3.36%, 86.74%±3.61%, and 89.62%±2.62%, respectively, with significant differences (P<0.05). The results of multiple linear regression analysis showed that the width and length were positively linear with the uncovered area of the prosthesis, and the regression equation was as follows: uncovered area of the prosthesis=−21.192+0.248×width+0.140×length, and the coefficient of determination R2=0.857, P<0.001. Conclusion Compared with the traditional method, the modified method can more accurately evaluate the cup coverage rate during THA, and the width of the uncovered area of the prosthesis can be used as an effective reference for the cup coverage rate.