Comparison of acetabular and femoral component positioning with and without fluoroscopy in direct anterior approach total hip arthroplasty

Background: 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. Methods: 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. Results: 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). Conclusion: 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.