COMPARING ACETABULAR COMPONENT POSITION IN DIRECT ANTERIOR APPROACH TOTAL HIP ARTHROPLASTY USING FLUOROSCOPY VERSUS IMAGELESS NAVIGATION
Bibliographic record
Abstract
Intraoperative fluoroscopy is commonly used in direct anterior approach (DAA) total hip arthroplasty (THA) to improve component positioning and minimize leg length discrepancy (LLD). However, imageless optical navigation systems have been shown to reduce the frequency of positional outliers in acetabular cup position in lateral and posterior approach THA. The aim of this study was to compare the accuracy and precision of fluoroscopy to that of an imageless optical navigation system in DAA THA. A retrospective cohort study was conducted on 640 primary DAA THAs performed with intraoperative fluoroscopy (n=300 patients) or imageless optical navigation (n=304 patients). Accuracy was compared between fluoroscopy and navigation by measuring acetabular cup inclination, anteversion, and LLD. The proportion of components placed within the Lewinnek safe zone was evaluated, as well as those placed within a more precise target range of ± 5° from the surgical target (40° ± 5° inclination, 20° ± 5° anteversion). There was a difference between fluoroscopy and navigation THA in mean acetabular inclination (40.4° SD: 4.7° vs. 42.0° SD: 3.74° respectively, p < 0 .001) and anteversion (17.9° SD: 4.7° vs. 20.3° SD: 3.6° respectively, p < 0 .001). There was no significant difference in the percentage of components positioned within the Lewinnek safe zone (90.3% vs 88.8% respectively, p=0.519). When using the more precise targets, navigation increased the proportion of acetabular components positioned correctly (fluoroscopy: 50.3% vs navigation: 65.6%, p < 0 .01). Mean LLD was higher with use of fluoroscopy compared to navigation (5.5 mm SD: 4.1 mm vs. 4.6 mm SD: 3.4 mm respectively, p < 0 .001). Both fluoroscopy and imageless optical navigation result in accurate component positioning for DAA THA. Navigation was more precise and associated with improved acetabular anteversion placement and restoration of LLD. Navigation is an accurate alternative to fluoroscopy while also reducing radiation exposure to the patient and operating team.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".