Preoperative Pelvic Tilt Analysis Reduces Fluoroscopy Time in Direct Anterior Total Hip Arthroplasty

Abstract

The direct anterior approach for total hip arthroplasty (THA) requires the use of intraoperative imaging, exposing the patient and surgical team to radiation. The authors hypothesized that calculation of the preoperative pelvic tilt angle and communication of this value with the fluoroscopy technician may result in a decrease in intraoperative fluoroscopy use. The study also examined total radiation exposure during the procedure to ensure that it was within safe limits. The pelvic tilt was calculated preoperatively for 100 consecutive patients undergoing THA by the direct anterior approach. The fluoroscopy technician was blinded to the value of pelvic tilt for the first 50 cases (control group), with the angle being communicated for the following 50 cases (test group). The total duration of fluoroscopy use for each case was recorded. The values were compared for the 2 experienced technicians involved in the study. The surgeon was blinded to the duration of fluoroscopy use in all cases. Mean fluoroscopy time was 28.65 seconds in the control group and 23.61 seconds in the test group (P=.033). No significant difference in duration of fluoroscopy use was found between the 2 fluoroscopy technicians. The control group and the test group were within safe limits of radiation exposure to both the patient and the surgical team. Preoperative pelvic tilt calculation significantly decreases the amount of imaging used during THA by the direct anterior approach. Although it was a statistically significant reduction, both groups were within safe limits for both the surgical team and the patients, and thus the clinical significance is unknown. [Orthopedics.2016; 39(5):e962-e966.].