Objective:

To compare the use of ipsilateral versus contralateral hip as a radiographic reference in reducing fluoroscopy use during direct anterior approach total hip arthroplasty (DAA-THA).

Approach:

• Study Design: Retrospective review of 159 primary cementless DAA-THA procedures performed by a single orthopedic surgeon.
• Patient Population: Adult patients undergoing primary THA for osteoarthritis with available intraoperative fluoroscopic images and radiation exposure reports.
• Comparison: Contralateral hip group (77 procedures) vs. ipsilateral hip group (82 procedures).
• Measurements: Fluoroscopy time, radiation dose, and operative time were compared between the two techniques.

Key Findings:

• Mean fluoroscopy time was 60.4 seconds for contralateral and 55.9 seconds for ipsilateral technique; not statistically significant.
• Mean radiation dose was 15.4 mGy for contralateral and 13.0 mGy for ipsilateral technique; not statistically significant.
• Ipsilateral technique had lower normalized fluoroscopy time (0.34 vs. 0.39 arbitrary units) and radiation dose (0.08 vs. 0.10 arbitrary units); both statistically significant.
• Mean operative time was longer with ipsilateral technique (164.6 minutes) compared to contralateral (154.3 minutes); statistically significant.
• BMI was moderately positively correlated with radiation dose and operative duration, but weakly correlated with fluoroscopy time.

Interpretation:

Ipsilateral reference may reduce fluoroscopy use relative to operative duration, although absolute fluoroscopy times and radiation doses were similar between techniques.

Limitations:

• Retrospective and nonrandomized study design.
• Single surgeon's procedures may introduce bias.
• Learning-curve bias as ipsilateral technique was used predominantly later in the study.
• Non-standardized image intensifier settings.
• Operative time as an imperfect surrogate for case complexity.
• No assessment of final clinical or radiographic outcomes.
• Limited sample size following BMI stratification reduced statistical power.

Conclusion:

Both techniques resulted in comparable absolute fluoroscopy use, but the ipsilateral technique may require less fluoroscopy relative to operative duration.

Sources:

• Cureus