Does a fluoro-assisted direct anterior approach for total hip arthroplasty pose an excessive risk of radiation exposure to the surgeon?

Abstract

Introduction: Intraoperative fluoroscopy can be easily used because patients are placed in the supine position during total hip arthroplasty via direct anterior approach (DAA-THA) to reduce complications. However, the cumulative level of radiation exposure by intraoperative fluoroscopy increases as the annual number of cases increases, increasing the risk of influencing the health of both the patients and medical workers. The objective of the study was to compare the radiation exposure time of DAA-THA with osteosynthesis and to determine if the level of radiation exposure exceeded safety limits. Material and methods: DAA-THA was performed in 313 patients between January 2016 and July 2018 and 60 patients with proximal femoral fracture were treated with osteosynthesis. The intraoperative fluoroscopy time was retrospectively surveyed and compared between these two groups. A total of eight surgeons operated DAA-THA employing the same procedure using a traction table. A total of nine surgeons operated osteosynthesis and fluoroscopy was appropriately used during reduction and implant insertion. Results: The mean operative time of DAA-THA was 103.3 min and that of osteosynthesis was 83.3 min, showing a significant difference (p < 0.05). The mean intraoperative fluoroscopy time was 0.83 min (SD ± 0.68) in DAA-THA and 8.91 min (SD ± 8.34) in osteosynthesis showing a significant difference (p < 0.05). Conclusions: The intraoperative exposure level was significantly lower and the fluoroscopy time was significantly shorter in DAA-THA than in osteosynthesis for proximal femoral fracture. It was clarified that the annual cumulative radiation exposure level in DAA-THA does not exceed the tissue dose limit.

Accuracy of acetabular cup placement during anterolateral supine total hip arthroplasty using intraoperative fluoroscopy: a retrospective study

“…Fluoroscopy is often used in orthopedic surgery, even for common fracture surgery, and radiation exposure is an unavoidable problem for orthopedic surgeons and staff. Jinnai et al reported significantly shorter fluoroscopy time and lower radiation exposure level for DAA-THA compared to proximal femur fractures [ 16 ]. In a recent systematic review, it was also reported that radiation exposure level during anterior THA is low and does not affect the surgeon or patient [ 17 ].…”

Direct anterior approach hip arthroplasty: How to reduce complications - A 10-years single center experience and literature review

“…There are some uncommon complications that are still to be taken into account; Hogerzeil et al [ 6 ] reported the case of a 69-year-old male patient who developed acute compartment syndrome of the thigh after elective DAA THA while using therapeutic low molecular weight heparin as bridging for regular oral anticoagulation. Also the risk of excessive radiation exposure to both the patients and the surgeons has to be considered; Jinnai et al [ 54 ] compared the intraoperative fluoroscopy time of DAA-THA with that of osteosynthesis for proximal femoral fracture to determine if the level of radiation exposure exceeded safety limits and concluding that the intraoperative exposure level was significantly lower and the fluoroscopy time was significantly shorter in DAA-THA than in osteosynthesis.…”

Hip arthroplasty for unstable femoral trochanteric fractures using the direct anterior approach

“…A traction table has several advantages such as traction of the lower limb enabling acetabular operation, ease of retention of the limb position for femoral operation, and prevention of intraoperative fracture during reduction [21]. In addition, health damage due to the exposure time becomes problematic for both patients and operators as the number of patients increases [22]. In general, the uoroscopy time required for the reduction procedure and internal xation is long in osteosynthesis of unstable femoral trochanteric fractures, and a similar tendency was noted in this study.…”