Fluoroscopy Computer Navigation Versus Manual Fluoroscopic Acetabular Positioning in Direct Anterior Total Hip Arthroplasty: Safe Zone Compliance and Learning Curve Analysis.
- 1Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Abstract
Background
Fluoroscopy is commonly leveraged in direct anterior approach total hip arthroplasty (DAA-THA). Computer-navigation systems provide real-time guidance aiming to enhance component positioning, but their learning curves and component accuracy remains incompletely characterized. This study evaluated the learning curve and safe zone compliance after implementation of computer navigation in DAA-THA.Methods
This retrospective cohort study analyzed 200 consecutive primary DAA-THA cases performed by a single high-volume surgeon: 100 manual and 100 computer-navigated cases using the Velys Hip Navigation system. Acetabular component inclination and anteversion were measured on postoperative standing radiographs. Safe zone compliance was assessed using surgeon-defined, Lewinnek, and Callanan criteria. Learning curve analysis utilized segmented linear regression and cumulative sum methods. Operative time, fluoroscopy exposure, and component safe zone compliance were compared between groups.Results
Operative time stabilized after 6 cases (P < .05), while significant breakpoint was identified for radiation exposure Computer navigated cases had shorter operative time (76.1 ± 16.4 vs 82.3 ± 17.0 minutes, P < .05) without increased fluoroscopy exposure (28.3 ± 6.6 vs 28.8 ± 9.8 seconds, P = .25). Safe zone compliance was significantly higher with navigation for surgeon-defined (98.9% vs 91.6%, P = .04), Lewinnek (86.3% vs 68.4%, P = .01), and Callanan criteria (68.4% vs 49.5%, P = .01).Conclusions
Fluoroscopic based computer navigation was associated with higher safe zone compliance in DAA-THA with a rapid 6-case learning curve and reduced operative time, without increasing radiation exposure.
Related
- Increased Accuracy of Acetabular Cup Positioning with an Automatic Impaction Device in Total Hip Arthroplasty
- Navigation-Assisted and Robotic Total Hip, Knee, and Unicompartmental Arthroplasty: Reconciling Positioning Accuracy with Biomaterial Performance and Long-Term Implant Survival.
- Fluoroscopic Catheter-Tip Positioning During Internal Jugular TIVAD Placement in Breast Cancer: A Two-Center Retrospective Cohort Study
- Comparison of Fluoroscopy Use Between Two Radiographic Overlay Techniques for Limb Length and Femoral Offset Assessment During Direct Anterior Approach Total Hip Arthroplasty
- Comparing Short-Term Clinical Outcomes and Survivorship of Complex Revision Total Hip Arthroplasty: Custom Triflange Acetabular Implants Vs Standard Cage Reconstruction
BibTeX
@article{zepeda2026fluoroscopy,
title = {{Fluoroscopy Computer Navigation Versus Manual Fluoroscopic Acetabular Positioning in Direct Anterior Total Hip Arthroplasty: Safe Zone Compliance and Learning Curve Analysis.}},
author = {Karlos E Zepeda and Carmelo Burgio and Shrey Vachhani and Tsion Yared and Edward Grabov and Jonathan M Vigdorchik and Eytan M Debbi},
journal = {Arthroplasty today},
year = {2026},
month = sep,
doi = {10.1016/j.artd.2026.102080},
url = {https://europepmc.org/article/MED/42910000},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Fluoroscopy Computer Navigation Versus Manual Fluoroscopic Acetabular Positioning in Direct Anterior Total Hip Arthroplasty: Safe Zone Compliance and Learning Curve Analysis.
AU - Karlos E Zepeda
AU - Carmelo Burgio
AU - Shrey Vachhani
AU - Tsion Yared
AU - Edward Grabov
AU - Jonathan M Vigdorchik
AU - Eytan M Debbi
PY - 2026
DA - 2026/09/28
JO - Arthroplasty today
DO - 10.1016/j.artd.2026.102080
UR - https://europepmc.org/article/MED/42910000
AB - Background Fluoroscopy is commonly leveraged in direct anterior approach total hip arthroplasty (DAA-THA). Computer-navigation systems provide real-time guidance aiming to enhance component positioning, but their learning curves and component accuracy remains incompletely characterized. This study evaluated the learning curve and safe zone compliance after implementation of computer navigation in DAA-THA.Methods This retrospective cohort study analyzed 200 consecutive primary DAA-THA cases performed by a single high-volume surgeon: 100 manual and 100 computer-navigated cases using the Velys Hip Navigation system. Acetabular component inclination and anteversion were measured on postoperative standing radiographs. Safe zone compliance was assessed using surgeon-defined, Lewinnek, and Callanan criteria. Learning curve analysis utilized segmented linear regression and cumulative sum methods. Operative time, fluoroscopy exposure, and component safe zone compliance were compared between groups.Results Operative time stabilized after 6 cases (P < .05), while significant breakpoint was identified for radiation exposure Computer navigated cases had shorter operative time (76.1 ± 16.4 vs 82.3 ± 17.0 minutes, P < .05) without increased fluoroscopy exposure (28.3 ± 6.6 vs 28.8 ± 9.8 seconds, P = .25). Safe zone compliance was significantly higher with navigation for surgeon-defined (98.9% vs 91.6%, P = .04), Lewinnek (86.3% vs 68.4%, P = .01), and Callanan criteria (68.4% vs 49.5%, P = .01).Conclusions Fluoroscopic based computer navigation was associated with higher safe zone compliance in DAA-THA with a rapid 6-case learning curve and reduced operative time, without increasing radiation exposure.
SN - 2352-3441
ER -