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J Arthroplasty. 2014 Mar;29(3):580-5. doi: 10.1016/j.arth.2013.08.003. Epub 2013 Sep 26.

Use of intraoperative X-rays to optimize component position and leg length during total hip arthroplasty.

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  • 1Division of Orthopaedic Surgery, Scripps Clinic, La Jolla California. Electronic address:
  • 2Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Health, La Jolla, California.


Proper femoral and acetabular component position and leg length equality are important intraoperative considerations during total hip arthroplasty. Unfortunately, traditional surgical techniques often lead to suboptimal component position, and such deviations have been associated with increased rates of prosthetic wear, dislocation, component loosening, and patient dissatisfaction. Although surgical navigation has been shown to improve reproducibility of component alignment, such technology is not universally available and is associated with significant costs and additional surgical/anesthetic time. In the current study, we found that a routine intraoperative pelvic radiograph could successfully identify malpositioned components and leg length inequalities and could allow for successful correction of identified problems. Unexpected component malposition and leg length inequality occurred in only 1.5% of cases where an intraoperative pelvic radiograph was utilized.


hip navigation; hip radiographs; intraoperative hip radiographs; total hip arthroplasty; total hip component alignment

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