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Radiographic factors to predict operation time of direct anterior total hip arthroplasty for dysplastic hips

Background: This study aimed to identify radiographic factors that could predict surgical difficulty in direct anterior total hip arthroplasty (THA) for dysplastic hips. Patients and Methods: The clinical records of 160 patients (204 hips) who underwent primary THA for the treatment of developmental dysplasia of the hip were retrospectively investigated. All THAs were performed through a direct anterior approach by a single surgeon. A multiple regression analysis was developed to identify the independent predictor of operation time, including variables such as age, sex, height, body mass index (BMI), the use of bone cement, previous hip surgery, and radiographic references, including the pelvic horizontal to vertical ratio, the extent of proximal and horizontal migration of the femoral head, flatness of the femoral head, and the vertical distance between the tips of the greater trochanter and the femoral head. Results: A multiple regression analysis revealed that as radiographic factors, proximal migration of the femoral head, and lower position of the femoral head related to the greater trochanter were significantly associated with longer operation time. In addition, our results revealed that younger age, male sex, height, high BMI, cement use, and previous hip surgery were also significantly associated with longer operation time. Conclusions: Our findings indicate that proximal migration of the femoral head and high-riding greater trochanter are isolated radiographic predictors of the longer operation time of direct anterior THA for dysplastic hips.