Does intraoperative fluoroscopy improve acetabular component positioning and limb-length discrepancy during direct anterior total hip arthroplasty? A meta-analysis

Abstract

Background The positioning of implant components for total hip arthroplasty (THA) is essential for joint stability, polyethylene liner wear, and range of motion. One potential benefit of the direct anterior approach (DAA) for THA is the ability to use intraoperative fluoroscopy for acetabular cup positioning and limb-length evaluation. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during DAA have reported conflicting results. This meta-analysis aimed to evaluate whether intraoperative fluoroscopy improves component positioning compared to no fluoroscopy during direct anterior total hip arthroplasty. Methods A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched Web of Science, EMBASE, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving intraoperative fluoroscopy versus no fluoroscopy during direct anterior total hip arthroplasty. Finally, we identified 1262 hips assessed in seven studies. Results There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.21), ACIA within safe zone rate (P = 0.97), acetabular cup anteversion angle (ACAA, P = 0.26); ACAA within safe zone rate (P = 0.07), combined safe zone rate (P = 0.33), and limb-length discrepancy (LLD, P = 0.21) between two groups. Conclusion Even though intraoperative fluoroscopy was not related to an improvement in cup location or LDD. With fewer experienced surgeons, the benefit of intraoperative fluoroscopy might become more evident. More adequately powered and well-designed long-term follow-up studies were required to determine whether the application of the intraoperative fluoroscopy for direct anterior total hip arthroplasty will have clinical benefits and improve the survival of prostheses.

Intraoperative Fluoroscopy Versus Navigation to Determine Cup Anteversion in Direct Anterior Total Hip Replacement: A Technical Trick for Obtaining “True” Anteversion

“…A recent meta-analysis by Sun et al., which compared fluoroscopy to nonfluoroscopic methods found no significant differences between surgeons using intraoperative fluoroscopy and those using alternative methods with regard to cup inclination, cup anteversion, or combined cup positioning that were within the “safe zone” or limb-length discrepancy. [ 20 ] This further supports the findings of this current study, which showed noninferiority of utilizing fluoroscopy when compared to computer-assisted navigation. Therefore, while fluoroscopy is an easily accessible and reliable tool, further studies with a higher sample size are needed to determine if this method is superior at replicating the optimal cup positioning and association with good postoperative outcomes.…”

The Sum of the Leg Length Discrepancy and the Difference in Global Femoral Offset Is Equal to That of the Contralateral Intact Side and Improves Postoperative Outcomes after Total Hip Arthroplasty: A Three-Dimensional Analysis

“…First, the surgeon should initially perform accurate pre-operative 3D planning according to our study results. Even without a navigation or robotic system, the use of fluoroscopy may improve postoperative outcomes by reproducing GFO and LLD close to those of the pre-operative plan [ 34 , 35 ]. Therefore, we considered that adopting our findings to perform THA in the supine position, such as the anterolateral supine or direct anterior approach, is more reasonable to confirm GFO, LLD, and SGL using intra-operative fluoroscopy [ 16 ].…”