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Component placement accuracy of two digital intraoperative fluoroscopy supplementation systems in direct anterior total hip arthroplasty

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Intraoperative fluoroscopy (IF) may increase accuracy of component placement when performing direct anterior approach total hip arthroplasty (THA), however, unguided IF continues to produce inconsistent results. Supplementation of IF, with a digital grid (Grid) system or digital overlay (Overlay), may increase component placement accuracy. The purpose of this study was to compare component placement accuracy following THA when IF was supplemented with the Grid or Overlay technique.

Materials and methods

Acetabular abduction and anteversion, with leg length discrepancy (LLD) and global hip offset (GHO) were retrospectively evaluated for unilateral and bilateral THA patients from 6-week post-operative radiographs. Target component placement were GHO and LLD < 10 mm, abduction 45° ± 10° and anteversion 15° ± 10° for Overlay and 17° ± 10° for Grid. Differences between the Overlay and Grid were determined by univariate analyses.

Results

The Overlay and Grid groups included 178 patients (217 hips) and 262 patients (317 hips), respectively. Target placement with the Overlay and Grid was achieved for GHO in 98.3% and 95.7% of cases (p = 0.108), LLD in 100% and 98.4% of cases (p = 0.121), cup abduction in 98.2% and 97.4% of cases (p = 0.384), and cup anteversion in 97.7% and 71.1% of cases (p < 0.001), respectively. Surgical time was significantly longer in Overlay compared to Grid (Unilateral 77.5 ± 14.1 min and 68.8 ± 12.2; p < 0.001; Bilateral 184.6 ± 27.0 min and 165.5 ± 23.1; p < 0.001, respectively).

Conclusion

Although no difference was found between the Grid and the Overlay cohorts for LLD, GHO or abduction angle, the Overlay resulted in greater accuracy for acetabular component anteversion angle, with only a slight decrease in surgical efficiency.

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Funding

This research received no specific grant from any funding agency in the public, commercial or non-for-profit sectors.

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Authors and Affiliations

  1. John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA

    Tyler Thorne

  2. Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96818, USA

    Scott Nishioka, Samantha Andrews, Kristin Mathews & Cass Nakasone

  3. Department of Surgery, University of Hawai’i, John A. Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA

    Samantha Andrews & Cass Nakasone

Authors
  1. Tyler Thorne
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  2. Scott Nishioka
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  3. Samantha Andrews
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  5. Cass Nakasone
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Corresponding author

Correspondence to Samantha Andrews.

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Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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 Hawai’i Pacific Health Research Institute (local Western Institutional Review Board) approved this study.

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This was a retrospective chart review and data collected were deidentified and presented as large scale, aggregate data. Therefore, no informed consent was obtained or required by the IRB.

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Thorne, T., Nishioka, S., Andrews, S. et al. Component placement accuracy of two digital intraoperative fluoroscopy supplementation systems in direct anterior total hip arthroplasty. Arch Orthop Trauma Surg 142, 1283–1288 (2022). https://doi.org/10.1007/s00402-021-04008-6

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  • DOI: https://doi.org/10.1007/s00402-021-04008-6

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