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Fluoroscopy may help decrease limb-length discrepancy but does not improve cup positioning
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Researchers found utilizing an anterior spine approach with intraoperative fluoroscopy helped decrease the occurrence of limb-length discrepancy greater than 1 cm; however, fluoroscopy use did not improve cup positioning precision.
The researchers performed a retrospective radiographic review of 100 patients who underwent primary total hip arthroplasty (THA) through a posterolateral approach in the lateral decubitus position (group one) and 100 patients who underwent primary THA using an anterior supine approach with intraoperative fluoroscopy (group two). All patients were being treated for osteoarthritis, rheumatoid arthritis or osteonecrosis, and none of the patients had a preoperative limb-length discrepancy of greater than 15 mm or significant acetabular bone loss.
The surgeons’ goal was to equalize the limb length discrepancy, with an anteversion target range of 15° to 35° between the two operating surgeons. All cups and stems used were cementless.
Two radiographic measurements for limb-length discrepancy, cup inclination and cup anteversion were taken at 4-week intervals using a picture archiving and communication system.
Results showed the mean limb-length discrepancy for groups one and two were 2.7 mm and 0.7 mm, respectively. Seven percent of hips in group one had a limb length discrepancy larger than 1 cm compared with 3% of the hips in group two.
Among hips implanted using the posterolateral approach, the researchers observed a limb-length discrepancy ranging from −9.8 mm to 20.9 mm and a total spread of 30.7 mm, whereas patients who underwent implantation with fluoroscopic guidance and an anterior approach had a discrepancy range of −11.8 to 10.5 mm and a total spread of 22.4 mm.
Patients in group one had a mean inclination of 40.8° compared with a mean inclination of 43.4° in group two. Ninety-six percent of cups in group one had an inclination within 10° compared with the 92% of cups in group two. Additionally, 87% of hips in group one had an anteversion within 10° of the mean compared with 76% of hips in group two.
The clinical significance of limb-length discrepancy reduction observed with use of the anterior approach with intraoperative fluoroscopy was unclear, according to the researchers. ‒ by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
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