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Supine versus lateral position for total hip replacement: accuracy of biomechanical reconstruction



Restoration of normal hip anatomy and biomechanics is a key surgical goal for success in total hip arthroplasty. The aim of this study was to evaluate the influence, if any, that patient positioning in the supine and lateral decubitus positions has in achieving this goal.

Materials and methods

A single center multi-surgeon case-matched series from a tertiary level referral center of patients undergoing primary unilateral THA for osteoarthritis between April 2018 and December 2019 was retrospectively analyzed. Patients (n = 200) were divided into two matched groups: supine (anterior approach, n = 100) and lateral decubitus (direct lateral or posterior/SuperPATH™ approaches, n = 100). Post-operative anteroposterior pelvic radiographs were analyzed using a previously validated software (SurgiMap, Nemaris Inc., USA) for parameters of reconstruction of the hip in the coronal plane; leg length discrepancy, vertical and horizontal displacement of the center of rotation, femoral offset, and total offset.


Mean absolute leg length discrepancy in the supine group was 0.6 ± 3.3 mm (95% [CI] − 0.1 to 1.2 mm) versus 2.4 ± 3.8 mm (95% [CI] 1.6 to 3.1) in the lateral decubitus position (p < 0.001). The center of rotation was displaced medially by a mean of 3.2 ± 2.7 mm in the supine group versus 1.3 ± 4.0 mm in the lateral decubitus group (p < 0.001). For a surgical target of reconstructing both leg length and total offset within 5 mm of native anatomy, the supine group was more than twice as likely to achieve these goals with fewer outliers (OR 2.631, 95% [CI] 1.901–3.643) (76% v 30%, p < 0.001).


Total hip arthroplasty through the anterior approach in the supine position is more consistent and accurate for the restoration of leg length and total offset. Further study is required to assess how this translates with outcome.

Level of evidence

III—retrospective cohort study.

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Niall P. McGoldrick would like to acknowledge the support of the Irish Institute of Trauma & Orthopaedic Surgery and the Royal College of Surgeons in Ireland towards his fellowship.


The authors did not receive support from any organization for the submitted work.

Author information




Study conception and design were performed by NPM, PEB, and GG. Material preparation, data collection and analysis were performed by all authors. The first draft of the manuscript was written by NPM and GG and all authors commented on previous versions of the manuscript. All authors have read and approved the final submitted manuscript.

Corresponding author

Correspondence to George Grammatopoulos.

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Conflict of interest

Authors A, B, C, and D declare they have no financial interests. Author E has received royalties from Corin, MicroPort, Medacta; has received consultancy fees from Corin, MicroPort, MatOrtho, Zimmer Biomet; has received research support from Zimmer Biomet; has received publishing royalties from Wolters Kluwer and is a committee member for the International Society for Hip Arthroscopy. Author F has received consultancy fees from Formus Labs. The authors have no conflicts of interest to disclose that are related to the submitted work.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Ottawa Health Science Network Research Ethics Board at The Ottawa Hospital (No. 2006856) approved this study.

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Informed consent was obtained from all individual participants included in the study.

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McGoldrick, N.P., Antoniades, S., El Meniawy, S. et al. Supine versus lateral position for total hip replacement: accuracy of biomechanical reconstruction. Arch Orthop Trauma Surg (2021).

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  • Arthroplasty
  • Hip
  • Anterior approach
  • Center of rotation