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

• Published in: The Journal of arthroplasty 2018-09, Vol.33 (9), p.2927-2931
• Main Authors: Bingham, Joshua S., Spangehl, Mark J., Hines, Jeremy T., Taunton, Michael J., Schwartz, Adam J.
• Format: Article
• Language: English
• Subjects: acetabular component position; Acetabulum - surgery; Aged; anterior hip arthroplasty; anteversion; Arthroplasty, Replacement, Hip - methods; direct anterior approach; Female; Fluoroscopy - methods; Hip Joint - surgery; Hip Prosthesis; Humans; inclination; intraoperative fluoroscopy; Leg Length Inequality - diagnostic imaging; Male; Middle Aged; Patient Positioning; Postoperative Period; Radiography; Retrospective Studies; Surgeons
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2018.05.004

One potential benefit of the direct anterior approach (DAA) for total hip arthroplasty is the ability to use intraoperative fluoroscopy for acetabular cup positioning and limb-length evaluation. Previous studies comparing the use of fluoroscopy with an anterior approach to a posterior approach have reported conflicting results. To our knowledge, no prior study has compared acetabular cup position and limb-length discrepancy (LLD) using a DAA with and without fluoroscopy. We retrospectively reviewed the charts of 298 patients who underwent direct anterior total hip arthroplasty with or without intraoperative fluoroscopy. All procedures were performed by 2 surgeons who use DAA as their primary approach. Preoperative and 6-week postoperative low anteroposterior pelvis and cross-table lateral radiographs were reviewed by 3 independent surgeons. Acetabular cup inclination, anteversion, and LLD were measured and compared. Thirty-three patients were excluded for inadequate imaging, leaving 125 patients in the fluoroscopy group and 140 patients in the nonfluoroscopy group. Mean inclination, anteversion, and LLD were 39.4° (95% confidence interval [CI], 38.5°-40.2°), 30.2° (95% CI, 29.2°-31.2°), and 1.1 mm (95% CI, 0.1 mm-2.2 mm) for the fluoroscopy group and 39.9° (95% CI, 39.3°-40.5°), 31.1° (95% CI, 30.0°-32.2°), and 0.8 mm (95% CI, −0.1 mm to 1.6 mm) for the nonfluoroscopy group. There was no significant difference in acetabular inclination (P = .35), anteversion (P = .22), or postoperative LLD (P = .64) between groups. This study found no clinically or statistically significant difference in acetabular inclination, anteversion, or LLD between the fluoroscopy and nonfluoroscopy groups. Both surgeons achieved a similar mean acetabular cup position and an equivalent mean LLD.