Hip Arthroplasty Does Not Require a Hana Table
A hip arthroplasty can be safely and effectively performed on either a specialized traction table (such as the Hana table) or a standard operating room table, with the choice being based on surgeon preference and specific clinical circumstances rather than absolute necessity.
Evidence Supporting Both Approaches
The direct anterior approach (DAA) for total hip arthroplasty was originally developed using specialized traction tables, but contemporary evidence demonstrates equivalent outcomes with standard tables 1, 2, 3.
Standard Table Advantages
When comparing standard operating tables to traction tables for DAA hip arthroplasty, the standard table approach offers several perioperative benefits:
- Shorter operative time: 70.9 minutes versus 100.1 minutes 3
- Reduced blood loss: 382 mL versus 532 mL 3
- Lower intraoperative fracture rate: 1.3% versus 1.7% 3
- More accurate leg length restoration: 2.4 mm discrepancy versus 3.7 mm 2
A matched-control study found no cases of leg length discrepancy >10 mm when performed without a traction table, compared to 2.7% with a traction table 2.
Equivalent Clinical Outcomes
Both techniques demonstrate similar patient-reported outcomes, satisfaction scores, complication rates (including dislocations, revisions, and periprosthetic fractures), and implant positioning accuracy 1, 2, 3. One study of 322 patients showed no differences in outcome measures at 4 months and 1 year, with satisfaction rates and complication rates being equivalent between groups 1.
Clinical Decision-Making Algorithm
Choose a standard operating table when:
- Cost containment is a priority
- Specialized traction equipment is unavailable
- Precise intraoperative leg length comparison is desired
- Minimizing operative time and blood loss is important
Consider a traction table when:
- Surgeon has extensive experience with this setup
- Facility has invested in specialized equipment
- Technical ease of femoral exposure is prioritized (particularly during the learning curve)
Important Caveats
While traction tables may offer technical ease during the learning curve 4, 5, the 5-year implant survival rate remains excellent (99.2%) regardless of table choice 5. The learning curve primarily affects perioperative metrics like surgical time and blood loss, but has minimal impact on mid-term outcomes 5.
The key determinant of success is surgeon familiarity and comfort with their chosen technique, not the specific table used 1. Surgeons should utilize the approach and setup they are most comfortable with to achieve optimal patient outcomes.