Intraoperative Imaging in Total Hip Arthroplasty is Cost-effective Regardless of Surgical Approach

Published:January 05, 2022DOI:



      Component positioning in total hip arthroplasty (THA) may be improved with utilization of intraoperative imaging. The purpose of this study was to determine if intraoperative imaging during THA is cost-effective.


      A break-even analysis was used as a model for cost-effectiveness, which incorporates cost of imaging (including direct charges and the additional time required for imaging), rate of revision surgery, and cost of revision surgery, yielding a final revision rate that needs to be achieved with use of intraoperative imaging in order for its use to be; cost-effective. Absolute risk reduction (ARR) is determined by the difference between the initial revision rate and final revision rate.


      At an anticipated institutional cost of $120 and requiring 4 additional minutes, intraoperative fluoroscopy would be cost-effective if the baseline rate of revision due to component mispositioning (0.62%) is reduced to 0.46%. Intraoperative flat plate radiographs ($127) are cost-effective at an ARR of 0.16%. Cost-effectiveness is achieved with lower ARR in the setting of lower imaging costs ($15, ARR 0.02%), and higher ARR with higher imaging costs ($225, ARR 0.29%). ARR for cost-effectiveness is independent of baseline revision rate, but varies with the cost of revision procedures.


      At current revision rates for component malpositioning, only 1 revision among 400 THAs needs to be prevented for the utilization of fluoroscopy (or 1 in 385 THAs with flat plate imaging), to achieve cost-effectiveness.


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