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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015


Acetabular component orientation can directly influence dislocation rates, polyethylene wear, and revision rates. Precise placement has been found to occur in only 38–47% after total hip arthroplasty (THA). The recent introduction of digital radiography (DR) has enabled a paradigm shift in intra-operative imaging technology. Rather than deal with the cumbersome process of chemical image processing we can now acquire a high quality digital image in a matter of seconds. The functionality approaches that of fluoroscopy, or even a C-arm, however, a digital system can operate with lower radiation, higher resolution, and perhaps most importantly a larger field of view. These features make it very suitable for use during surgery. The purpose of this presentation is to illustrate the current intra-operative technique and share the overwhelmingly positive experience gathered over the past five years.

Traditional THA employs use of post-operative radiography for “outcome assessment.” This unfortunately does not allow the surgeon to evaluate the relevant parameters and make necessary adjustments without returning to the operating room. Digital imaging, however, permits intra-operative guidance and “outcome control.” It provides an immediate and complete preview of what the post-operative film will show. There is now an opportunity to optimise component orientation, sizing, apposition, screw position, limb length, and offset, before leaving the operating room. This can be done with minimal intrusion on normal workflow, adding only a few minutes of operating time.