Association between intraoperative fluoroscopy for anterior approach total hip arthroplasty and short-term revision risk: an analysis based on 49,878 cases from the Dutch Arthroplasty Register
DOI:
https://doi.org/10.2340/17453674.2026.45966Keywords:
Arthroplasty, Fluoroscopy, HipAbstract
Background and purpose: Intraoperative fluoroscopy during primary total hip arthroplasty (THA) can be used to assist in component positioning in order to optimize placement and restore hip kinematics. Whether fluoroscopy leads to superior outcomes is subject to debate. We aimed to examine the use of fluoroscopy in the Netherlands and determine the association between the use of fluoroscopy and short-term revision risk following primary THA via the direct anterior approach (DAA).
Methods: We included 49,878 primary THAs, performed via DAA, registered in the LROI from 2022–2024. Competing risk analysis and multivariable Cox-regression analyses were used to assess differences in implant survival between use of fluoroscopy and conventional surgery. Hazard ratios (HR) were adjusted for body mass index, previous surgeries, and fixation, and stratified for age, ASA class, and diagnosis.
Results: Unadjusted cumulative incidence of revision after 6 months, 1, 2, and 2.5 years did not show significant differences: the 2.5-year revision rate was 1.7% (95% confidence interval [CI] 1.5–1.9) for the fluoroscopy group, and 2.0% (CI 1.8–2.3) in the conventional group. Multivariable analysis demonstrated that the use of fluoroscopy was associated with a significantly lower risk of revision than conventional surgery (HR 0.8, CI 0.7–0.9).
Conclusion: The use of intraoperative fluoroscopy in primary THA via DAA in the Netherlands is associated with a significantly lower short-term risk of revision. The data showed no major differences in revision due to malalignment and periprosthetic fractures. Revision rates were low in both groups and clinical differences were only small.
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Copyright (c) 2026 Marije Carlijn Vink, Wierd P Zijlstra, Liza N van Steenbergen, Paulien A van Veen, Peter F Doorn, Jesse W P Kuiper, Rinne M Peters
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