Subscribe to RSS
A Novel Measurement Using Digital Radiography to Minimize Fluoroscopy in Total Hip ArthroplastyFunding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Preoperative templating for total hip arthroplasty (THA) is fraught with uncertainty. Specifically, the conventional measurement of the lesser trochanter to the center (LTC) of the femoral head used in preoperative planning is easily measured on a template but not measurable intraoperatively. The purpose of this study was to examine the utility of a novel measurement that is reproducible both on templating and in surgery as a more accurate and practical guide. We retrospectively reviewed 201 patients with a history of osteoarthritis who underwent primary THA. For preoperative templating, the distance from the top of the lesser trochanter to the equator (LeTE) of the femoral head was measured on a calibrated digital radiograph with a neutral pelvis. This measurement was used intraoperatively to guide the choice of the trial neck and head. As with any templating technique, the goal was to construct a stable, impingement-free THA with equivalent leg lengths and hip offset. In evaluating this novel templating technique, the primary outcomes measured were the number of trial reductions and the amount of fluoroscopic time, exposures, and radiation required to obtain a balanced THA reconstruction. Using the LeTE measurement, the mean number of trial reductions was 1.21, the mean number of intraoperative fluoroscopy images taken was 2.63, the mean dose of radiation exposure from fluoroscopy was 0.02 mGy, and the mean fluoroscopy time per procedure was 0.6 seconds. In hips templated with the conventional LTC prior to the LeTE, the mean fluoroscopy time was 0.9 seconds. There was a statistically significant difference in fluoroscopy time (p < 0.001). The LeTE is a reproducible measurement that transfers reliably from digital templating to surgery. This novel preoperative templating metric reduces the fluoroscopy time and consequent radiation exposure to the surgical team and may minimize the number of trial reductions.
Received: 18 August 2020
Accepted: 26 January 2021
15 June 2021 (online)
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Della Valle AG, Padgett DE, Salvati EA. Preoperative planning for primary total hip arthroplasty. J Am Acad Orthop Surg 2005; 13 (07) 455-462
- 2 Shaarani SR, McHugh G, Collins DA. Accuracy of digital preoperative templating in 100 consecutive uncemented total hip arthroplasties: a single surgeon series. J Arthroplasty 2013; 28 (02) 331-337
- 3 Eggli S, Pisan M, Müller ME. The value of preoperative planning for total hip arthroplasty. J Bone Joint Surg Br 1998; 80 (03) 382-390
- 4 Wang Q, Xiao J, Zhu L. et al. Acetate templating on calibrated standing digital radiograph improves accuracy of preoperative templating for total hip arthroplasty. Orthop Traumatol Surg Res 2017; 103 (03) 341-347
- 5 Gorski JM, Schwartz L. A device to measure X-ray magnification in preoperative planning for cementless arthroplasty. Clin Orthop Relat Res 1986; (202) 302-306
- 6 Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 2005; 441: 115-124
- 7 Yun A, Qutami M, Pasko KBD. Salvage of failed femoral neck fracture fixation with conversion total hip arthroplasty using the direct anterior approach. Hip Pelvis 2020; 32 (04) 199-206
- 8 Yun A, Qutami M, Pasko KBD. Conversion total hip arthroplasty with a direct anterior approach for failed treatment of acetabular fractures. J Hip Surg 2020; 4: 129-133
- 9 Curtin BM, Armstrong LC, Bucker BT, Odum SM, Jiranek WA. Patient radiation exposure during fluoro-assisted direct anterior approach total hip arthroplasty. J Arthroplasty 2016; 31 (06) 1218-1221
- 10 Pomeroy CL, Mason JB, Fehring TK, Masonis JL, Curtin BM. Radiation exposure during fluoro-assisted direct anterior total hip arthroplasty. J Arthroplasty 2016; 31 (08) 1742-1745
- 11 Jinnai Y, Baba T, Zhuang X. et al. Does a fluoro-assisted direct anterior approach for total hip arthroplasty pose an excessive risk of radiation exposure to the surgeon?. SICOT J 2020; 6: 6
- 12 McArthur BA, Schueler BA, Howe BM, Trousdale RT, Taunton MJ. Radiation exposure during fluoroscopic guided direct anterior approach for total hip arthroplasty. J Arthroplasty 2015; 30 (09) 1565-1568
- 13 McNabb DC, Jennings JM, Levy DL, Miner TM, Yang CC, Kim RH. Direct anterior hip replacement does not pose undue radiation exposure risk to the patient or surgeon. J Bone Joint Surg Am 2017; 99 (23) 2020-2025
- 14 Weeks CA, Preston S, Howard JL, Vasarhelyi EM, Matz J, Lanting BA. Preoperative pelvic tilt analysis reduces fluoroscopy time in direct anterior total hip arthroplasty. Orthopedics 2016; 39 (05) e962-e966