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Does Fluoroscopy Improve Acetabular Component Placement in Total Hip Arthroplasty?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The success of THA largely depends on correct placement of the individual components. Traditionally, these have been placed freehand using anatomic landmarks, but studies have shown poor accuracy with this method.

Questions/purposes

Specifically, we asked (1) does using fluoroscopy lead to more accurate and greater likelihood of cup placement with the Lewinnek safe zone than does freehand cup placement; (2) is there a learning curve associated with the use of fluoroscopy for cup placement; (3) does the use of fluoroscopy increase operative time; and (4) is there a difference in leg length discrepancy between freehand and fluoroscopic techniques?

Methods

This series consisted of 109 consecutive patients undergoing primary THA, conversion of a previous hip surgery to THA, and revision THA during a 24-month period. No patients were excluded from analysis during this time. The first 52 patients had cups placed freehand, and then the next 57 patients had acetabular components placed using fluoroscopy; the analysis began with the first patient treated using fluoroscopy, to include our initial experience with the technique. The abduction, version, and limb length discrepancy were measured on 6-week postoperative pelvic radiographs obtained with the patient in the supine position. Operative time, sex, age, BMI, diagnosis, operative side, and femoral head size were recorded as possible confounders.

Results

Cups inserted freehand were placed in the ideal range of abduction (30°–45°) and anteversion (5°–25°) 44% of the time. With fluoroscopy, placement in the Lewinnek safe zone for both measures significantly increased to 65%. The odds of placing the cup in the Lewinnek safe zone for abduction and version were 2.3 times greater with the use of fluoroscopy (95% CI, 1.2–5.0; p = 0.03). Patients undergoing primary THAs (32 freehand, 35 C-arm) had cup placement in the safe zone for abduction and version 44% of the time freehand and 57% of the time with fluoroscopy, which failed to reach statistical significance. There was no difference in operative time, patient age, sex, operative side, diagnosis, limb length discrepancy, or femoral head size between the two groups.

Conclusions

The use of fluoroscopy to directly observe pelvic position and acetabular component placement increased the success of placement in the Lewinnek safe zone in this cohort of patients having complex and primary THAs. This is a simple, low-cost, and quick method for increasing successful acetabular component alignment. The study population included a large proportion of patients having complex THAs, and further validation of this technique in patients undergoing straightforward, primary THAs needs to be done to understand if similar gains in accuracy for component placement can be expected in that group.

Level of Evidence

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank David Zurakowski PhD (Departments of Anesthesiology and Surgery, Boston Children’s Hospital, Boston, MA) for assistance with the statistical analyses in the current study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA

    Brandon S. Beamer MD, Jordan H. Morgan BS, Michael J. Weaver MD & Mark S. Vrahas MD

  2. Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Brandon S. Beamer MD, Jordan H. Morgan BS & Mark S. Vrahas MD

  3. Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA

    Christopher Barr BS

Authors
  1. Brandon S. Beamer MD
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  2. Jordan H. Morgan BS
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  3. Christopher Barr BS
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  4. Michael J. Weaver MD
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  5. Mark S. Vrahas MD
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Corresponding author

Correspondence to Brandon S. Beamer MD.

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

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Beamer, B.S., Morgan, J.H., Barr, C. et al. Does Fluoroscopy Improve Acetabular Component Placement in Total Hip Arthroplasty?. Clin Orthop Relat Res 472, 3953–3962 (2014). https://doi.org/10.1007/s11999-014-3944-8

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  • DOI: https://doi.org/10.1007/s11999-014-3944-8

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