Digital Radiography During Total Hip Arthroplasty: Early Results With a Combined Anteversion Technique

Ideal component positioning is critical to outcomes in total hip arthroplasty. We describe our early results using digital radiographs with a combined ante-version technique. We report the incidence of component adjustments made based on digital radiographs and show how this technology can be used during patient positioning to achieve appropriate starting pelvic alignment. We reviewed 176 cases of primary total hip arthroplasty performed by a single arthroplasty surgeon using a posterior approach. Mean follow-up was 1 year (range, 3 months to 2.7 years). Digital radiographs (Surgeon's Checklist Hip; Radlink) and a combined anteversion technique were used for component positioning. For a subset of 100 patients, we recorded the incidence of pelvic mal-positioning found on digital radiographs obtained during initial positioning of the patient. For this same subset we also detail the component changes made as a result of intraoperative radiographs during trialing. Among 176 cases we have had 2 (1.1%) postoperative dislocations. Both underwent closed reduction with no further dislocation. We have had no revisions and 1 intraoperative calcar fracture. For our 100-case subset, digital radiographs during patient positioning identified pelvic malpositioning greater than 5° (coronal or axial plane) among 17% of cases. During trialing, we made component adjustments 71% of the time because of findings on intraoperative imaging. Digital radiography can be a valuable tool for component positioning during total hip arthroplasty. We experienced favorable early outcomes and show the utility of digital radiographs for proper pelvic positioning and making intraoperative adjustments to achieve optimal component placement. [Orthopedics. 2022;45(4):221-226.].