Does Intraoperative Fluoroscopy Improve Limb-Length Discrepancy and Acetabular Component Positioning During Direct Anterior Total Hip Arthroplasty?

Bingham, Joshua S.; Spangehl, Mark J.; Hines, Jeremy T.; Taunton, Michael J.; Schwartz, Adam J.

doi:10.1016/j.arth.2018.05.004

Cited by 48 publications

(44 citation statements)

References 26 publications

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“…A previous study found that DAA was associated with a larger percentage of acetabular cups placed within the "safe" zone of alignment when using uoroscopy [25], which corroborates our ndings.…”

Section: Discussionsupporting

confidence: 92%

Direct Anterior Versus Anterolateral and Posterolateral Approaches to Total Hip Replacement: Comparative Accuracy of Acetabular Implant Placement and Early Clinical Outcomes

Chen

Horng

Hsieh

et al. 2021

Preprint

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BackgroundDifferent surgical approaches used in total hip arthroplasty (THA) include direct anterior approach (DAA), anterolateral approach (AL), and posterolateral approach (PL). However, the acetabular cup position varies according to surgical view, surgical table, and patient position for each approach. This study is aimed to compare acetabular cup position in THA under different approaches, including surgical time, blood loss, and postoperative complications.MethodsBetween Jan 2017 and Dec 2018, 231 patients who underwent THA (64 DAA, 96 AL, and 71 PL THAs) were analyzed retrospectively. Intraoperative blood loss, operation time, preoperative and postoperative WOMAC score, cup anteversion, inclination angle, and postoperative complications were analyzed.ResultsDAA showed longer operation time and more blood loss, but shorter hospital stays. The cup was found in the safe zone for 97% of DAA patients, 74% of AL patients, and 56% of PL patients. PL showed the highest complication rate (9.9%), followed by DAA (3.1%) and AL (1%). There was no statistically significant difference in preoperative and postoperative WOMAC scores. ConclusionTHA by DAA using a special table is a more reliable procedure to achieve safe cup position. Although DAA showed fewer outliers in cup position, it resulted in longer operation time and greater blood loss compared to other groups.Trial registration: Retrospective study

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Section: Discussionsupporting

confidence: 92%

Direct Anterior Versus Anterolateral and Posterolateral Approaches to Total Hip Replacement: Comparative Accuracy of Acetabular Implant Placement and Early Clinical Outcomes

Chen

Horng

Hsieh

et al. 2021

Preprint

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“…Equalisation of leg length was uncomplicated. Bingham et al [32] reported no difference in leg length inequality between the use or not of the fluoroscopy in DAA.…”

Section: Discussionmentioning

confidence: 97%

“…Five hundred and twenty five THA performed on 474 patients were included retrospectively from May 2013 to December 2017 in a university training hospital. Three hundred and sixty one THA were performed by a senior surgeon and 164 by six junior surgeons (mean = 27 patients [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] ± 8) with the same experience (five years of residency learning PA) supervised by the senior. The senior surgeon had performed the DAA technique for one year before supervising the trainees.…”

Section: Methodsmentioning

confidence: 99%

Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

Foissey

Fauvernier

Fary

et al. 2020

SICOT-J

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Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

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“…They were unable to determine if the improved radiographic parameters were owed to the approach or the use of fluoroscopy. Bingham et al [36] performed a recent investigation of 2 cohorts of patients undergoing THA via the DAA. They retrospectively reviewed radiographs for 3 primary parameters: LLD, acetabular inclination, and acetabular anteversion.…”

Section: Discussionmentioning

confidence: 99%

Does the use of intraoperative fluoroscopy improve postoperative radiographic component positioning and implant size in total hip arthroplasty utilizing a direct anterior approach?

et al. 2020

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Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) has gained recent popularity, with 1 purported benefit being access to intraoperative fluoroscopy. However, there are limited data demonstrating improved component position with the use of intraoperative fluoroscopy. The aim of this study is to compare radiographic implant positioning on 2 consecutive cohorts of patients undergoing DAA THA performed by 1 surgeon either utilizing intraoperative fluoroscopy or not. We hypothesized that there would be no relevant radiographic differences between the cohorts. Methods: Forty-two consecutive patients underwent DAA THA utilizing fluoroscopy (IFC), and 42 consecutive patients then underwent DAA THA without fluoroscopy (NFC). Using preoperative pelvis radiographs and 6-week postoperative pelvis radiographs, acetabular anteversion, inclination, femoral offset, and templated component sizes vs final intraoperatively selected sizes were recorded and compared between cohorts. Results: Acetabular inclination was 45.0 for IFC and 45.6 for NFC (P ¼ .629). Femoral offset difference preoperatively and postoperatively was 0.8 mm for IFC and 1.3 mm for NFC (P ¼ .734). Number of hips within the so-called safe zone was 32 for IFC and 33 for NFC (P ¼ .794). These all demonstrated no significant difference between the cohorts. However, acetabular anteversion was 13.7 for IFC and 11.2 for NFC (P ¼ .02). Conclusions: In this limited series, the routine use of intraoperative fluoroscopy did not improve implant positioning or sizing. This may be surgeon-specific or due to the result of the use of acetabular landmarks to guide placement of the components without fluoroscopy.

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Does Intraoperative Fluoroscopy Improve Limb-Length Discrepancy and Acetabular Component Positioning During Direct Anterior Total Hip Arthroplasty?

Cited by 48 publications

References 26 publications

Direct Anterior Versus Anterolateral and Posterolateral Approaches to Total Hip Replacement: Comparative Accuracy of Acetabular Implant Placement and Early Clinical Outcomes

Direct Anterior Versus Anterolateral and Posterolateral Approaches to Total Hip Replacement: Comparative Accuracy of Acetabular Implant Placement and Early Clinical Outcomes

Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

Does the use of intraoperative fluoroscopy improve postoperative radiographic component positioning and implant size in total hip arthroplasty utilizing a direct anterior approach?

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Does Intraoperative Fluoroscopy Improve Limb-Length Discrepancy and Acetabular Component Positioning During Direct Anterior Total Hip Arthroplasty?

Cited by 48 publications

References 26 publications

Direct Anterior Versus Anterolateral and Posterolateral&nbsp;Approaches to Total Hip Replacement: Comparative Accuracy of Acetabular Implant Placement and Early Clinical Outcomes

Direct Anterior Versus Anterolateral and Posterolateral&nbsp;Approaches to Total Hip Replacement: Comparative Accuracy of Acetabular Implant Placement and Early Clinical Outcomes

Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

Does the use of intraoperative fluoroscopy improve postoperative radiographic component positioning and implant size in total hip arthroplasty utilizing a direct anterior approach?

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Product

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Direct Anterior Versus Anterolateral and Posterolateral Approaches to Total Hip Replacement: Comparative Accuracy of Acetabular Implant Placement and Early Clinical Outcomes

Direct Anterior Versus Anterolateral and Posterolateral Approaches to Total Hip Replacement: Comparative Accuracy of Acetabular Implant Placement and Early Clinical Outcomes