Carbon fiber traction table use is associated with a lower incidence of stress shielding and cortical hypertrophy after total hip arthroplasty: a case-control study.

BACKGROUND

The carbon fiber traction table is a specialized platform designed for direct anterior approach (DAA) total hip arthroplasty (THA), providing independent leg traction, controlled rotation, and unobstructed intraoperative fluoroscopy. In this study, we evaluated the impact of carbon fiber traction table use on postoperative bone remodeling, three-dimensional (3D) component alignment, and clinical outcomes following DAA THA.

METHODS

We retrospectively reviewed primary THAs performed between 2019 and 2024. The cohort comprised 43 hips operated using a standard operating table (S group) and 58 hips operated using a carbon fiber traction table (H group). All procedures in the S group were performed without intraoperative fluoroscopy, whereas intraoperative fluoroscopy was routinely used in the H group to confirm component alignment. Radiographic bone remodeling was assessed 1 year postoperatively. Component alignment was evaluated using 3D computed tomography obtained 1 week after surgery, and clinical data were extracted from medical records.

RESULTS

Mean operative time was significantly shorter in the H group than in the S group (89.0 vs. 96.4 min). The incidences of stress shielding (55.1% vs. 79.0%) and cortical hypertrophy (27.5% vs. 67.4%) were significantly lower in the H group than in the S group. Diaphyseal fit fixation was more common in the S group than in the H group (67.4% vs. 37.9%), and the mean stem size was significantly larger (12.39 vs. 11.20). No significant differences were observed in cup or stem alignment between the groups. Multivariable logistic regression analysis identified the use of a standard operating table and stovepipe femoral morphology as independent predictors of stress shielding.

CONCLUSIONS

In DAA THA, the use of a carbon fiber traction table was associated with lower rates of stress shielding and cortical hypertrophy at 1 year postoperatively, despite comparable component alignment. Although the independent effects of the carbon fiber traction table and intraoperative fluoroscopy could not be fully distinguished, the use of a carbon fiber traction table may contribute to more favorable postoperative bone remodeling.