The effect of c-arm tilt on accuracy of intraoperative fluoroscopy in assessing acetabular component position during direct anterior approach for hip arthroplasty

Intraoperative fluoroscopy can improve the precision of acetabular component positioning during direct anterior hip arthroplasty. However, changes in pelvic tilt with c-arm positioning may compromise accuracy. A geometric model of an acetabular component's projection onto fluoroscopy images was created and manipulated to simulate c-arm tilt. An apparently ideally-placed cup will have its effective anteversion changed by 7.5° with just 10° of caudal/cephalad tilt of the c-arm. This effect is greater in cups that are more horizontally placed or less anteverted. Accurate c-arm positioning is crucial, as small errors in tilt can have considerable effects on final cup position.