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

Autor: Bingham JS; Orthopaedic Department, Mayo Clinic, Phoenix, Arizona., Spangehl MJ; Orthopaedic Department, Mayo Clinic, Phoenix, Arizona., Hines JT; Orthopaedic Department, Mayo Clinic, Rochester, Minnesota., Taunton MJ; Orthopaedic Department, Mayo Clinic, Rochester, Minnesota., Schwartz AJ; Orthopaedic Department, Mayo Clinic, Phoenix, Arizona.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2018 Sep; Vol. 33 (9), pp. 2927-2931. Date of Electronic Publication: 2018 May 28.
DOI: 10.1016/j.arth.2018.05.004
Abstrakt: Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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