A new method for intraoperative assessment of leg length, sizing and placement of the components in total hip replacement.

Abstract

Intraoperative radiograph of the pelvis is a well-established way to avoid misplacement/undersizing of the components and leg length discrepancy (LLD) in total hip replacement (THR). We describe a method for the obtainment and the evaluation of intraoperative radiographs with a sophisticated wireless radiographic system and a computerized digital tool originally used for preoperative templating. In this retrospective case-control study, 60 patients with unilateral hip osteoarthritis who underwent THR with intraoperative radiographic check with the conventional method (n = 30, control group) or the new method (AGFA flat panel DR14eG™/Orthosize™, n = 30, case group) were evaluated and compared for operation time, intraoperative changes in size/placement of the components and final radiological outcome (LLD, acetabular inclination and femoral offset) based on postoperative radiographs of the pelvis. Mean operation time was lower in case group (85.3 min vs. 103.3 min, p value < 0.005), as well as mean absolute LLD (1.93 mm vs. 2.94 mm, p value = 0.242). There was a higher percentage of intraoperative changes in the offset of the prostheses' head (70% vs. 40%, p value = 0.018) and a significantly lower percentage of patients with LLD > 5 mm in the case group (0% vs. 27%, p value = 0.002). This new method for the obtainment and assessment of intraoperative radiographs proved to be fast and assuring for keeping LLD below 5 mm in all patients.