A Review of Fluoroscopy in Direct Anterior Approach Total Hip Arthroplasty: Principles, Safety, and Clinical Applications.

Abstract

Fluoroscopy has become an increasingly valuable adjunct in performing total hip arthroplasty (THA) through the direct anterior approach (DAA). Its intraoperative use allows surgeons to confirm acetabular cup inclination and anteversion, optimize femoral offset and leg length, and recognize potential sources of malposition or complications intraoperatively. This review outlines the principles of fluoroscopic imaging during DAA THA, including optimal C-arm positioning, image orientation, and techniques to minimize parallax and distortion. Emphasis is placed on radiation safety and workflow integration to maintain surgical efficiency. Current evidence supports fluoroscopy as a reliable tool for improving component accuracy and reducing leg length discrepancies without compromising surgical time or increasing complication rates. Understanding common pitfalls such as magnification error and inconsistent limb positioning remains critical to accurate interpretation. When properly applied, fluoroscopy enhances intraoperative decision making and allows surgeons to achieve consistent, reproducible outcomes. This review provides practical guidance and evidence-based insights to help orthopaedic surgeons safely and effectively incorporate fluoroscopy into DAA THA practice.