Intraoperative fluoroscopy with a direct anterior approach reduces variation in acetabular cup abduction angle



The purpose of this study was to compare acetabular cup position for 2 cohorts of total hip arthroplasty (THA) patients who had a direct anterior approach.


100 THA cases were performed with an anterior approach using intraoperative fluoroscopy (IF) to aid in cup positioning. Another group of 100 cases underwent THA with an anterior approach without the use of any fluoroscopy. Postoperative abduction and anteversion angles were measured using Martell’s hip analysis software.


Mean abduction angle was 43.2° (standard deviation (SD) = 4.5°) for the IF group versus 37.5°(SD = 7.4°) for cases without IF (p<0.001). 18% more cases with IF fell within the Lewinnek safe zone (p<0.001); however, a similar number of cases had over 50° of abduction. The mean anteversion angles of the two groups were also significantly different (IF 21.8° vs. 24.9°) (p<0.01).


There was significantly less variation in cup position among the cases using IF with regards to abduction.

Hip Int 2017; 27(6): 573 - 577




Gens P. Goodman, Nitin Goyal, Nancy L. Parks, Robert H. Hopper Jr., William G. Hamilton

Article History


Financial support: Inova Health System.
Conflict of interest: N.G. and W.H. are paid consultants at Cayenne Medical, Stryker Orthopedics, and DePuy. Our research institute receives institutional support from DePuy, Biomet, Nimbic Systems, and Inova Health Systems.

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  • Anderson Orthopaedic Research Institute, Alexandria, Virginia - USA

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