Johns B, Selznick A, Wood T, Winemaker M, Tushinski D, Ekhtiari S, Bali K
Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
Juravinski Hospital, Hamilton Health Sciences, Ontario, Canada.
J Orthop. 2025 May 26;70:166-172. doi: 10.1016/j.jor.2025.05.050. eCollection 2025 Dec.
The direct anterior approach (DAA) for total hip arthroplasty (THA) continues to increase. Accurate component placement can be guided by intra-operative fluoroscopy, but there is a lack of comprehensive comparative data on final implants guided or not guided by intra-operative fluoroscopy in DAA THA. This study aims to compare acetabular and femoral component positioning along with surgical time in DAA THA with and without intra-operative fluoroscopy.
All patients with DAA THA for osteoarthritis by an arthroplasty surgeon at a university teaching hospital from March 2021 to March 2024 were evaluated. Demographic, implant data, post-operative radiographic measurements and surgical times were compared between fluoroscopy and non-fluoroscopy groups.
Overall, 354 patients who had DAA THA were included. In 200 patients, fluoroscopy was not used and in 154 patients, fluoroscopy was used. Groups were compared using 2825 radiographic measurements. There was no significant difference between groups for safe acetabular inclination (p = 0.792) or anteversion (p = 0.906), satisfactory femoral component coronal alignment (p = 0.071), femoral component undersizing (p = 0.476) and leg length discrepancy (p = 0.726). More patients in the fluoroscopy group had femoral offset restored (65.6 %; fluoroscopy vs 54.3 %; non-fluoroscopy, p = 0.038). The surgical time was longer in the fluoroscopy group (60 min; fluoroscopy vs 42 min; non-fluoroscopy, p < 0.001).
In DAA THA for osteoarthritis most parameters regarding implant positioning with or without fluoroscopy are not significantly different except for femoral offset. Additionally, surgical time is significantly shorter without the use of fluoroscopy.
全髋关节置换术（THA）的直接前路入路（DAA）的应用持续增加。术中透视可引导假体组件精确放置，但在DAA THA中，缺乏关于术中透视引导或未引导下最终植入物的全面比较数据。本研究旨在比较在有或无术中透视情况下，DAA THA中髋臼和股骨组件的定位以及手术时间。
对2021年3月至2024年3月在一所大学教学医院由关节置换外科医生进行DAA THA治疗骨关节炎的所有患者进行评估。比较透视组和非透视组的人口统计学、植入物数据、术后影像学测量结果和手术时间。
总体而言，纳入了354例行DAA THA的患者。其中200例患者未使用透视，154例患者使用了透视。使用2825次影像学测量对两组进行比较。在安全髋臼倾斜度（p = 0.792）、前倾角（p = 0.906）、满意的股骨组件冠状位对线（p = 0.071）、股骨组件尺寸过小（p = 0.476）和肢体长度差异（p = 0.726）方面，两组之间无显著差异。透视组中有更多患者恢复了股骨偏心距（65.6%；透视组 vs 54.3%；非透视组，p = 0.038）。透视组的手术时间更长（60分钟；透视组 vs 42分钟；非透视组，p < 0.001）。
在治疗骨关节炎的DAA THA中，无论有无透视，大多数关于植入物定位的参数无显著差异，但股骨偏心距除外。此外，不使用透视时手术时间明显更短。
