Low pelvic incidence is a risk factor for intraoperative complications in minimally invasive anterolateral approach for total hip arthroplasty.

Background: Minimally invasive anterolateral approach (ALA) has gained popularity in recent years as better postoperative functional recovery and lower risk of postoperative dislocation are claimed. However, difficulties for femur exposure and intraoperative complications during femoral canal preparation and component placement have been reported. This study analyses the effect of anatomical factors on difficulties for femoral access and intraoperative complications with a modified minimally invasive ALA.

Material And Methods: 310 consecutive patients who had primary unilateral total hip arthroplasty (THA) by single surgeon using same approach and technique, and being suitable for EOS were included. All patients underwent pre- and postoperative standing and sitting full-body EOS acquisitions and pelvic and femoral parameters were measured. All intra- and postoperative complications for femoral preparation and implantation were assessed. Intraoperative complications included femoral fractures and difficulties for femoral exposure.

Results: 10 patients (3.2%) had intraoperative femoral fractures (2 greater trochanter, 8 calcar). Difficult access to the proximal femur was reported for 10 other patients (3.2%). Patients with intraoperative complications presented a significantly lower pelvic incidence (PI) than patients without intraoperative complications (mean PI: 39.4° vs. 56.9°,  < 0.001).

Conclusions: The pelvic incidence can be useful to detect anatomically less favourable patients for THA implantation using ALA.