title: Do we need intraoperative radiographs for positioning the femoral component in total hip arthroplasty?
abstract: BACKGROUND
  Poor long-term results of total hip arthroplasty (THA) can result from femoral component misalignment. There are few reports that discuss the effectiveness of intraoperative radiographs for placing femoral components. This study is a retrospective review to find out the usefulness of intraoperative radiographs in detecting and improving the femoral component misalignment in posterior-approached primary THA.
  
  
  METHODS
  The study group included 150 primary THAs performed between September 2009 and April 2012. After the trial component insertion in lateral decubitus position, intraoperative radiography was performed. The surgeon assessed the femoral component position in three aspects: alignment, leg length, and offset. If it is not following the preoperative template, the surgeon makes the intraoperative adjustments to change the femoral component position. After the operation, postoperative radiograph was taken; the same parameters were measured and were compared to intraoperative findings. The changes in each parameter were classified into three categories: satisfactory, no change, and unsatisfactory. Among the three parameters, if one is satisfactory and the others are not unsatisfactory, we defined it as accurate positioning of the femoral component.
  
  
  RESULTS
  Intraoperative adjustments were made in 122 cases (81.3 %). The adjustments included changes in the component size (35.3 %), component alignment (38.6 %), femoral offset (14.0 %), and additional femoral neck cuts (56.0 %). As a result, accurate positioning was successfully achieved in 112 cases (91.8 %) by taking intraoperative radiographs.
  
  
  CONCLUSIONS
  Our data suggest that intraoperative radiography is a useful method for detecting the errors of placing the femoral components, and the success of a surgeon to correct those errors after detecting them intraoperatively.
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, 920-8641, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Kuroda
authors.forename: Tamon
authors.initials: T
authors.lastname: Kabata
authors.forename: Toru
authors.initials: T
authors.lastname: Maeda
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Kajino
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D017760:Bone Malalignment / Q000517:prevention & control; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging*; D005272:Femur Neck / Q000000981:diagnostic imaging; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D017755:Prosthesis Fitting; D011859:Radiography; D012189:Retrospective Studies