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The accuracy of cup position in total hip arthroplasty is essential for a satisfactory result as malpositioning increases the risk of complications including dislocation, high wear rate, loosening, squeaking, edge loading, impingement and ultimately failure.We studied 166 patients in a single-surgeon-series of matched cohorts of patients who underwent total hip arthroplasties. Four separate groups were identified comprising of the posterior approach +/- navigation and the direct anterior approach +/- navigation.We found a significant difference between the direct anterior navigated group and the posterior non-navigated group for both anteversions (P < 0.05, confidence interval (CI) -3.86 to -1.73) and inclination (P < 0.05, CI -3.08 to -1.08). Almost, 72% of anterior navigated patients fell within 5o of the navigation software set target cup position of 45o inclination and 20o anteversion and 100% were within 10o. Only 30% of posterior non-navigated were within 5o of both anteversion and inclination and 73% were within 10o.There was also a significant difference between the direct anterior navigated and non-navigated group with respect to anteversion only (p < 0.05, CI 1.50 to 1.30). There were no other significant differences between approaches +/- navigation.The direct anterior approach allows ease of access to both anterior-superior iliac spines for navigation and a supine patient allows anteversion and inclination to be measured in the frontal plane. We conclude that the direct anterior approach with navigation improves the accuracy of cup position compared to the conventional posterior approach without navigation.

Adult-acquired flatfoot deformity is a progressive pathologic condition that results in a rigid, painful, arthritic flatfoot that is debilitating and affects daily function. Traditionally, the condition is treated with a Triple arthrodesis of the subtalar joint, talonavicular joint, and the calcaneocuboid joint through dual incisions. This approach is effective in restoring the medial arch and correcting excessive hindfoot valgus. However, the lateral incision is associated with wound-healing problems in up to one third of patients, while the calcaneocuboid joint is often asymptomatic and not arthritic. The medial-single-incision "Diple" arthrodesis is a valuable, efficient, and safe alternative to the traditional dual incision Triple arthrodesis. The Diple arthrodesis is performed through a single medial incision and is a fusion of the subtalar joint and talonavicular joint but sparing the calcaneocuboid joint. The advantages of the Diple arthrodesis is significantly reduced wound complication, decreased operating time, comparable union rates, and extensive intraoperative visualization. Furthermore, maintenance of the calcaneocuboid joint allows for improving accommodation on uneven surfaces along with prevention of adjacent joint degeneration. In this paper, we describe our experience with the medial-single-incision Diple arthrodesis in patients with adult-acquired flatfoot deformity.Level of Evidence: Diagnostic Level V-expert opinion and surgical technique. See Instructions for Authors for a complete description of levels of evidence.