The Journal of Hip Surgery 2022; 06(03): 091-096
DOI: 10.1055/s-0042-1750049
Original Article

Intraoperative Imaging Improves Posterolateral THA Accuracy with Increased Time Cost

William M. Ralston
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
Ajay Aggarwal
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
James A. Keeney
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
› Author Affiliations


Intraoperative imaging may improve total hip arthroplasty (THA) component placement, but the time and cost associated with this approach have not been well described. We assessed component placement accuracy, operative time, and operating room (OR) charges for 270 patients undergoing posterolateral THA (PL-THA) with or without intraoperative imaging. This study retrospectively compared 135 PL-THA performed with intraoperative digital radiography (group PLxr) and a contemporary cohort of 135 PL-THA performed without imaging (group PL). Postoperative radiographs were evaluated to determine outlier rates for acetabular inclination of 55 degrees or higher, anteversion less than 15 or more than 40 degrees, and leg length or offset differences more than 10 mm. Surgical procedure time was extracted from hospital OR records, and procedural costs were estimated from facility charges associated with 30-minute OR time blocks and intraoperative imaging. Group PLxr had significantly fewer outliers for acetabular inclination more than 50 degrees (5.2 vs. 21.5%, p < 0.001), acetabular inclination of 55 degrees or higher (0.7 vs. 8.1%, p = 0.01), acetabular anteversion less than 15 or more than 40 degrees (14.8 vs. 28.9%, p < 0.01), leg length difference more than 10 mm (2.2 vs. 10.4%, p = 0.01), and femoral offset difference more than 10 mm (1.5 vs. 9.6%, p < 0.01). The difference in component inclination less than 30 degrees was not significant (0.0 vs. 2.2%, p = 0.24). Intraoperative component adjustment occurred in 26 cases (21.5%), was associated with a 19-minute mean increase in operative time (p < 0.001) and $1,504 mean increase in facility charges compared with nonimaged cases. Imaged cases without component adjustment increased mean operative time by 9.4 minutes (p < 0.001) and mean operative charges by $766. Intraoperative imaging improves component placement accuracy during PL-THA and significantly reduces component placement outliers, particularly with respect to acetabular component inclination, femoral length, and femoral offset.

Level of Evidence Level III, case-control study.

Ethical Approval

This study was approved and executed under approval from the University of Missouri's Institutional Review Board (#2017063). No external funding was used in the execution of this study.

Publication History

Received: 11 August 2021

Accepted: 25 April 2022

Article published online:
28 June 2022

© 2022. Thieme. All rights reserved.

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