Short-Term Clinicoradiological Outcomes of Primary Total Hip Arthroplasty With and Without Intraoperative Fluoroscopic Guidance: A Comparative Prospective Non-randomised Controlled (Quasi-experimental) Study

Abstract

Abstract Introduction: The long-term success of total hip arthroplasty (THA) requires optimal acetabular component positioning. To improve implant placement, intra-operative fluoroscopy is increasingly used, yet the evidence remains limited in the Indian population and confined to the direct anterior approach. This study compares the clinicoradiological outcomes of primary THA performed through the posterolateral approach with and without intraoperative fluoroscopic guidance at a tertiary care institution. Materials and Methods: In this prospective non-randomised controlled (quasi-experimental) study, 70 patients undergoing primary THA between March 2024 and August 2025 were serially allocated, in order of admission, into 2 groups, either fluoroscopy-assisted (n = 35) or freehand technique (n = 35), performed by a single experienced surgeon through the posterolateral approach. Postoperatively, on anteroposterior pelvic radiographs and low-dose computed tomography radiological outcomes (cup inclination, cup anteversion, horizontal femoral offset, distance of cup from teardrop) were measured. Clinical outcomes included operative time, intraoperative blood loss, limb length discrepancy [LLD], dislocation rates and modified Harris Hip score (mHHS) at 6 weeks, 3 months and 6 months follow-up. Results: At baseline, both the study groups were comparable demographically. There was significant improvement in all radiological parameters postoperatively in both study groups. Cup inclination was significantly better in the fluoroscopy group (39.92° ± 3.59° vs. 37.84° ± 4.44°; P = 0.036), with narrow dispersion showing increased consistency. No significant differences were observed in cup anteversion (P = 0.699), horizontal femoral offset (P = 0.066), LLD (P = 0.235), distance from teardrop (P = 0.766), dislocation rate (P = 1.0), operative time (P = 0.147), blood loss (P = 0.987), or mHHS at 6 weeks (P = 0.735) or 3 months (P = 0.204) or 6 months (0.669). Conclusion: Intraoperative fluoroscopic guidance during posterolateral THA provides statistically significant improvement in acetabular cup inclination, but there were no measurable advantages in other radiological parameters, short-term functional outcomes, or complication rates when done by an experienced surgeon. Fluoroscopy functions to enhance precision and increases the consistency of component positioning rather than determining outcome in this context.