The Use of Intraoperative Digital Radiography Alignment Software to Assess Implant Placement in Total Hip Arthroplasty

Abstract

Purpose of review: Total hip arthroplasty (THA) is a highly successful surgery with growing rates of utilization in the USA, but surgical outliers leading to postoperative complications remain a concern. There is need for a standard system of accurate, predictable intraoperative evaluation to decrease component positioning outliers. Many current intraoperative imaging systems have shown promise, but there are drawbacks that have led to slow adoption. Digital radiography, in conjunction with Radlink™ technology, is a potential solution to this problem. This review summarizes the clinical application and scientific literature regarding the use of Radlink™ in THA.

Recent findings: Traditional surgeon-directed component placement can result in surgical outliers. This is especially true not only among low-volume arthroplasty surgeons, but can also occur with experienced, high-volume surgeons. Digital radiography allows for more precise and accurate placement of the acetabular cup in a targeted range in an effort to improve THA outcomes. Intraoperative images are obtained quickly, and they are accurate when compared to postoperative images. Additionally, the use of Radlink™ results in a significant decrease in leg length and femoral offset outliers. The adoption of Radlink™ technology in THA can significantly decrease surgical outliers, especially errors in acetabular cup placement, leg length, and femoral offset. Digital radiography avoids many of the previous aversions to intraoperative imaging as it produces a fast, reliable image with little radiation exposure and minimal interruption to workflow. There is the potential for Radlink™ use to provide superior patient outcomes, as a decrease in surgical outliers can minimize implant malpositioning with resultant need for revision THAs. Radlink™ may also provide benefit in analyzing other parameters, such as component sizing.

Keywords: Component positioning; Digital radiography; Intraoperative imaging; Radlink; Total hip arthroplasty.

Fig. 1

Radlink^TM Tower set up in the operating room, where the top screen can project the preoperative anteroposterior pelvis X-ray and the bottom screen shows intraoperative images for comparison

Fig. 2

Pre-operative anteroposterior hip radiograph with templated surgical plan for component sizing and positioning

Fig. 3

Image acquisition positioning of a sterile covered digital receiver at the patient’s back and the X-ray machine aiming at patient’s anterior pelvis in the lateral decubitus position

Fig. 4

Evidence of a malrotated X-ray with the anatomic measures of the coccygeal tip in relation to the pubic symphysis using the sacroiliac joints as a horizontal reference in addition to determinations of leg length and offset

Fig. 5

Adjusted anteroposterior pelvis image and calculation of component positioning and anatomical relationships