• Christian B Ong, Yu-Fen Chiu, Ajay Premkumar, and Gonzalez Della ValleAlejandroA0000-0002-2177-5919Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA. gonzaleza@hss.edu..
• Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
• Arch Orthop Trauma Surg. 2023 May 1; 143 (5): 273927452739-2745.

IntroductionDirect anterior approach (DAA) for total hip arthroplasty (THA) frequently utilizes fluoroscopy. The purpose of this study is to assess the impact of using a novel, imageless THA navigation system on radiation exposure and acetabular cup placement consistency.Materials And MethodsThis was a retrospective, single-surgeon cohort study of a consecutive group of patients who underwent DAA THA for osteoarthritis. An optic-based imageless navigation system was used to determine intraoperative acetabular inclination and anteversion angles referenced off of a generic coronal and sagittal plane in 71 cases (study group). These were compared with 71 manual cases (control group) for fluoroscopy exposure, operative duration, and acetabular placement variation. Cohorts were similar in their distributions of sex, race, ethnicity, and body mass index. Comparisons between groups were made using independent samples t tests. Alpha error was 0.05.ResultsStudy patients experienced significantly less fluoroscopy exposure time {3.59 [Standard Deviation (SD) 1.95] vs. 9.15 (SD 5.98) seconds; p < 0.001} and dosage (0.30 [SD 0.23] vs. 0.78 [SD 0.63] mGy; p < 0.001). Study and control patients had similar operative times [82.69 (SD 11.70) vs. 89.54 (SD 14.60) minutes; p = 0.09]. The study group had a significantly lower radiographic variation for inclination and anteversion, based on mean proximity to the centroid of each cohort [3.55 (SD 1.88) vs. 5.39 (SD 3.51); p < 0.001] and also a greater proportion of cases that fell within 1 SD of the mean cohort inclination and anteversion (40.8% vs. 21.1%; p = 0.009).ConclusionsUse of a novel imageless navigation system for DAA THA significantly reduced fluoroscopic radiation exposure and improved consistency in acetabular cup placement.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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