Intra-operative referencing technique is non-inferior to use of fluoroscopy for acetabular component positioning in anterior hip arthroplasty

Abstract

Background: Intra-operative fluoroscopy has been shown to improve the accuracy of acetabular component positioning when compared to no fluoroscopy in direct anterior approach (DAA) total hip arthroplasty (THA). Due to logistical reasons, our senior author has been performing DAA THA at one institution without the use of fluoroscopy and has created an intraoperative referencing technique to aid in acetabular component positioning. The purpose of this study is to evaluate the accuracy of acetabular component positioning using fluoroscopy when compared to an intra-operative referencing technique without fluoroscopy. Methods: A total of 214 consecutive primary DAA THA were performed by one surgeon at two institutions and were retrospectively reviewed over a 3-year period. Intra-operative fluoroscopy was used with all patients at Institution A (N ¼ 154). At institution B (N ¼ 60), no fluoroscopy was used, and an intra-operative referencing technique was employed to assist in placement of the acetabular component. Results: In the fluoroscopy group, 91% of components met our abduction target, 90% met our anteversion target, and 82.5% simultaneously met both targets. In the non-fluoroscopy group, 98% of components met our abduction target, 92% met our anteversion target, and 90% simultaneously met both targets. There was no difference between groups for placement of the component within both targets simultaneously (p ¼ .171). Conclusion: Use of our intra-operative referencing technique is non-inferior in placing acetabular components within a pre-defined safe zone when compared to use of intraoperative fluoroscopy. The intraoperative reference technique can be a helpful adjunct for ensuring accurate acetabular component positioning while simultaneously reducing cost and limiting radiation exposure.

Intraoperative imaging in hip arthroplasty: a meta-analysis and systematic review of randomized controlled trials and observational studies

“…To date, it remains unclear whether the benefit of intraoperative fluoroscopic control of the component position outweighs the potential disadvantages related to its use (longer operation times, higher costs and radiation exposure) [6,7]. Individual studies either failed to show a significant difference or found only small differences [8][9][10][11][12][13][14][15][16][17]. A formal meta-analysis on this topic has not been published.…”