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The impact of operative approach and intraoperative imaging on leg length discrepancy and acetabular component angle in total hip arthroplasty: a retrospective cohort study

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Abstract

Purpose

Operative approach in total hip arthroplasty (THA) has long been a topic of debate with each approach having unique benefits and disadvantages. One purported benefit of an anterior approach to THA is that it allows for intraoperative positioning using fluoroscopy rather than manual positioning. Proper positioning allows for improved outcomes including leg length discrepancy and acetabular component angle. This study aims to examine if operative approach and use of imaging in intraoperative positioning impact LLD and cup angle post-operatively.

Methods

A total of 300 hips were enrolled in the study with 100 hips per approach (anterior with fluoroscopy, lateral, and posterior). Retrospective chart review was conducted to assess patient demographics and radiographic analysis used to determine LLD and acetabular cup angle.

Results

Of the three groups, those receiving anterior approach THAs were on average older than those in the posterior group. Analysis comparing the LLD and acetabular angle across the three groups showed no statistically significant difference in LLD (p=0.091); this was also reflected when comparing hips that received fluoroscopy with those that did not (p=0.91). For acetabular angle, while no difference existed when comparing hips that received imaging versus those that did not, statistically significant differences were observed when comparing the three intraoperative approaches (p<0.0001).

Conclusions

Neither intraoperative approach nor the use of intraoperative imaging in THA has a statistically significant effect on LLD post-operatively. However, approach did impact the acetabular cup angle across all three distinct approaches.

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Authors and Affiliations

  1. University of Toronto, 27 King’s College Cir, Toronto, ON M5S, Canada

    Zoe Thompson, Amir Khoshbin, Sarah Ward, Jacqueline Brillantes & Amit Atrey

  2. St. Michael’s Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada

    Amir Khoshbin, Sarah Ward, Jacqueline Brillantes, Luana Melo, James P. Waddell & Amit Atrey

Authors
  1. Zoe Thompson
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  2. Amir Khoshbin
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  3. Sarah Ward
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  4. Jacqueline Brillantes
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  5. Luana Melo
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  6. James P. Waddell
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  7. Amit Atrey
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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Zoe Thompson, Jacqueline Brillantes, and Amit Atrey. The first draft of the manuscript was written by Zoe Thompson and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Zoe Thompson.

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Competing interests

Financial interests: Author ZT, LM, AK and JB declare they have no financial interests. SW has received fellowship support from Stryker and Smith & Nephew. AA has been a paid consultant for and received research support from ZB, Smith & Nephew, DePuy, Biocomposites, and Stryker; and has also received financial support for an educational project with ZB. JW is the current secretariat general of SICOT and a board member for JBJS, BJJ, and IO.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the University of Toronto REB #21-230.

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Thompson, Z., Khoshbin, A., Ward, S. et al. The impact of operative approach and intraoperative imaging on leg length discrepancy and acetabular component angle in total hip arthroplasty: a retrospective cohort study. International Orthopaedics (SICOT) 48, 473–479 (2024). https://doi.org/10.1007/s00264-023-05962-z

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  • DOI: https://doi.org/10.1007/s00264-023-05962-z

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