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Does fluoroscopy with anterior hip arthroplasty decrease acetabular cup variability compared with a nonguided

Parthiv A Rathod¹, Sean Bhalla, Ajit J Deshmukh

¹Center for Joint Preservation & Reconstruction, NorthshoreLIJ/Lenoxhill Hospital, 130 E 77th Street, 11th Floor, New York, NY, 10075, USA, drparthivrathod@gmail.com.

Clinical Orthopaedics and Related Research

|February 20, 2014

Summary

This summary is machine-generated.

Direct anterior approach total hip arthroplasty (THA) with fluoroscopy shows reduced variability in acetabular component placement compared to the posterior approach. Accuracy improves with experience, though a learning curve exists for the anterior method.

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Area of Science:

Orthopedic Surgery
Arthroplasty
Surgical Navigation

Background:

The direct anterior approach (DAA) for total hip arthroplasty (THA) presents advantages but involves a steep learning curve.
Intraoperative fluoroscopy may mitigate technical challenges and enhance acetabular component placement accuracy in DAA THA.

Purpose of the Study:

To compare acetabular cup inclination and anteversion variability between DAA THA with fluoroscopy and posterior approach THA without radiographic guidance.
To evaluate the learning curve associated with achieving accuracy in DAA THA.
To assess complication frequencies, including dislocation, for both approaches.

Main Methods:

Retrospective comparative analysis of 825 THAs (372 posterior, 453 DAA) performed by a single surgeon.
Radiographic analysis using specialized software to determine cup inclination and anteversion.
Inclusion of the first 100 DAA THAs as a learning curve group.

Main Results:

DAA THA demonstrated significantly lower variability in cup inclination (19 vs. 50) and anteversion (16 vs. 79) compared to the posterior approach.
Target inclination and anteversion were achieved more frequently with DAA (98% and 97%) versus posterior approach (86% and 77%).
The learning curve group showed slightly lower target anteversion achievement (91%) compared to the established DAA group (p=0.03).

Conclusions:

Intraoperative fluoroscopy during DAA THA allows for precise acetabular cup orientation, reducing placement variability.
A learning curve is present for achieving optimal accuracy with the DAA THA.
The study could not definitively attribute improved outcomes solely to the approach or the use of fluoroscopy.