Hip Offset and Leg Length Equalization in Direct Anterior Approach Total Hip Arthroplasty without Preoperative Templating

The standard practice of preoperative templating may be less important for direct anterior approach (DAA) total hip arthroplasty (THA) with intraoperative fluoroscopy (IF). However, this has yet to be tested. The purpose of this retrospective review was to report the hip offset (HO) and leg length (LL) equalization accuracy following 304 consecutively performed DAA THA with IF and no preoperative templating. A supplemental fluoroscopic gridding tool was used to assess hip symmetry. Operative and fluoroscopic times were also documented to assess for surgical efficiency. The mean HO and LL difference was 3.5 ± 2.6 mm (range: 0.0–9.3) and 2.9 ± 2.2 mm (range: 0.0–9.9), respectively. Hip offset and LL equalization within 10 mm was achieved in all patients. The mean operative time for unilateral THA was 72.2 ± 12.0 minutes, and the mean fluoroscopy time per hip was 10.5 ± 4.5 seconds. These results suggest that for surgeons with adequate experience performing DAA THA with IF, preoperative templating may not be necessary to reliably and efficiently achieve clinically acceptable HO and LL.