Utility of Intraoperative Fluoroscopic Positioning of Total Hip Arthroplasty Components Using a Posterior and Direct Anterior Approach

Abstract

Introduction Positioning of implant components for total hip arthroplasty (THA) is important for polyethylene liner wear, prosthesis joint stability, and range of motion. The introduction of fluoroscopy for the direct anterior approach has been shown to improve physician accuracy for component positioning. Few studies compare the use of intraoperative fluoroscopy for THA component positioning in posterior THA. The purpose of this project is to retrospectively evaluate the effect of intraoperative fluoroscopy on component positioning for THA using posterior and direct anterior approach (DAA). Materials and Methods A retrospective review of postoperative weight-bearing X-ray films of THAs was performed over a 2-year period where a single fellowship–trained total joint surgeon introduced direct anterior approach into his practice while expanding the intraoperative use of fluoroscopy for all THA procedures, regardless of approach. Component position was evaluated through radiographic measurement of acetabular cup inclination (goal of 40 degrees), limb length discrepancy (goal of 0 mm), and femoral component offset difference (goal of 0 mm). Radiographic analysis was performed by two independent providers. Statistical analysis was performed using Student’s t-tests. Results A total of 107 patients with an average age of 62 years were identified during the 2-year period surrounding the THA practice change, adding fluoroscopy to posterior and DAA THA. Three cohorts were identified: cohort A: 44 patients who underwent posterior THAs without the use of intraoperative fluoroscopy, cohort B: 35 patients who underwent direct anterior approach THAs with the use of intraoperative fluoroscopy, and cohort C: 18 patients who underwent posterior THAs with the use of intraoperative fluoroscopy. The use of intraoperative fluoroscopy for the posterior approach versus unguided posterior approach increased accuracy of both cup inclination (44 degrees vs 50 degrees, P < .05) and femoral offset (4 mm vs 7 mm, P < .05). A comparison of DAA with fluoroscopy versus posterior approach without fluoroscopy showed improvement in cup inclination (48 degrees vs 50 degrees, P < .05). Fluoroscopy with posterior approach versus fluoroscopy with DAA was found to have improved cup inclination (44 degrees vs 48 degrees, P < .05). Conclusion Intraoperative use of fluoroscopy can improve component positioning for posterior THA.

Comparison of Exeter stem offset size for total hip arthroplasty between males and females: A retrospective series of 780 hips

“…The use of the anterior approach as well as the use of intra-operative fluoroscopy have been proposed as methods to increase component accuracy. 12 It is purported that templating helps to achieve both of these objectives. Over recent years, templating has become an increasingly advanced process.…”

Accuracy and Precision of Acetabular Component Position Does Not Differ Between the Anterior and Posterior Approaches to Total Hip Arthroplasty With Robotic Assistance: A Matched-Pair Analysis

“…Belyea et al. [ 35 ] compared acetabular cup inclination among patients who underwent THA with the DAA and fluoroscopy (n = 35), PA with fluoroscopy (n = 44), and PA without fluoroscopy (n = 18). The authors reported that the use of PA with fluoroscopy significantly increased accuracy of cup inclination compared to PA without fluoroscopy and DAA with fluoroscopy.…”

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.…”