Hip resurfacing (HR) is an alternative to total hip arthroplasty in young, active patients; however, improper femoral implant positioning may increase failure risk. This study evaluated the feasibility and accuracy of custom guides for femoral cup positioning during HR via the direct anterior approach (DAA). Although custom guides have been used with other surgical approaches, their use via DAA has not been reported. Six patients underwent HR using preoperative 3D planning to align the femoral cup with the native femoral neck axis and avoid notching. Custom tripod-type guides were designed for medial femoral neck positioning. Radiographs assessed coronal neck-shaft angle (F-NSA) and profile (P-NSA) neck-shaft angles. No adverse events occurred. Implant sizes matched planned components except in one case requiring a larger cup. Median differences from planned values were −2 ° (range, −3.7 ° to 0.5 °) for F-NSA and 0 ° (range, −3 ° to +3 °) for P-NSA. No femoral notching occurred. Custom guides for HR via DAA are feasible and provide accurate positioning.

IV; prospective cohort study.