A prosthetic acetabular cup inserter and impactor has an expandable annular cup engaging element to engage the inner surface of a cup to be inserted in the acetabulum. An expander is provided for expanding the cup engaging element which is connected to one end of a handle via a hollow or partly hollow extension portion. The other end of the handle is provided with an anvil. An elongate operator is located within the extension portion and connected to the cup engaging element. A device is provided for moving the elongate operator to pull the cup engaging element towards the expander.
