Total hip arthroplasty via the direct anterior approach using a conventional traction table and fluoroscopy: a safe and cost-effective technique

Introduction: Precise implant positioning during total hip arthroplasty (THA) is an important factor affecting dislocation rate and long-term implant survival. Although a special carbon fiber traction table for THA improves the accuracy of implant positioning, it is too expensive. We aimed to report the accuracy of cup positioning and complication rate in patients undergoing THA using a conventional noncarbon fiber traction table, which is generally used for osteosynthesis of femoral fractures. Methods: This retrospective study included 62 patients who received primary THA via the direct anterior approach using a conventional traction table with fluoroscopy between July 2022 and December 2023. Two observers recorded radiological outcomes using postoperative anteroposterior X-rays. The intraclass correlation coefficients of cup positioning angles were evaluated (inclination: 0.92, anteversion: 0.88 for intra-observer agreement; inclination: 0.91, anteversion: 0.84 for inter-observer agreement). Complications were defined as dislocation, periprosthetic fracture, ankle fracture, implant loosening, nerve injury, surgical site infection, deep vein thrombosis, and revision surgery for any reason. Results: Radiographic analysis showed an average cup inclination of 38.5° ± 4.3° (98.4% within Lewinnek’s safe zone). The average cup anteversion was 12.6° ± 4.6° (100% within Lewinnek’s safe zone). None of the patients experienced any complications. Discussion: A conventional traction table could be a feasible alternative to a carbon fiber traction table for performing THA via the direct anterior approach using fluoroscopy at general hospitals.