The effect of intraoperative fluoroscopy on acetabular component positioning and patient anatomy restoration during total hip arthroplasty: A systematic review and meta-analysis

Background:In total hip arthroplasty (THA), the positioning of components holds critical importance for factors such as joint stability, polyethylene liner wear, and range of motion. This meta-analysis aimed to compare the effects of intraoperative fluoroscopy (IF) versus no use of IF on component positioning and the restoration of patient anatomy during THA. Methods:We conducted our systematic review following the recommendations outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The literature search was performed from the inception of medical databases up to August 2023. PubMed, Embase, Web of Science, Cochrane Controlled Trials Register, Cochrane Library, Highwire, Wanfang, China National Knowledge Infrastructure (CNKI), China Biology Medicine Disc (CBM), and China Science and Technology Journal (CSTD) databases were systematically searched to identify relevant studies comparing IF versus no IF during primary THA. Results:Thirteen studies involving 2195 patients (2207 hips) were incorporated in the Analysis. No statistically significant differences were observed between the groups in terms of acetabular cup inclination angle (ACIA, P = .9), ACIA within the safe zone rate (P = .87), acetabular cup anteversion angle (ACAA, P = .42), ACAA within the safe zone rate (P = .35), combined safe zone rate (P = .30), limb length difference (LLD, P = .13), dislocation rate (P = .76), and infection rate (P = .97). In comparison to the no fluoroscopy group, the IF group exhibited prolonged operation time (P < .00001) and reduced femoral component offset difference (FCOD, P = .03). Conclusion:IF did not demonstrate improvements in acetabular cup placement, limb length difference, or dislocation occurrence. Nonetheless, IF showed a significant enhancement in restoring femoral offset. It is noteworthy that surgeons operating in facilities with lower patient volumes may observe more pronounced benefits from IF.