Radiation Exposure during Fluoroscopic Guided Direct Anterior Approach for Total Hip Arthroplasty

McArthur, Benjamin A.; Schueler, Beth A.; Howe, Benjamin M.; Trousdale, Robert T.; Taunton, Michael J.

doi:10.1016/j.arth.2015.03.029

Cited by 25 publications

(15 citation statements)

References 25 publications

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“…somewhat operator dependent, and if not employed correctly, can actually be misleading in case of some morphological variants or with differences in pelvic and/or fluoroscopy arm positioning, paradoxically leading to component malposition [13]. There are also conflicting data regarding exposure to radiation during the operation, though most investigations have not shown this to be of high concern [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Does the use of intraoperative fluoroscopy improve postoperative radiographic component positioning and implant size in total hip arthroplasty utilizing a direct anterior approach?

et al. 2020

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Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) has gained recent popularity, with 1 purported benefit being access to intraoperative fluoroscopy. However, there are limited data demonstrating improved component position with the use of intraoperative fluoroscopy. The aim of this study is to compare radiographic implant positioning on 2 consecutive cohorts of patients undergoing DAA THA performed by 1 surgeon either utilizing intraoperative fluoroscopy or not. We hypothesized that there would be no relevant radiographic differences between the cohorts. Methods: Forty-two consecutive patients underwent DAA THA utilizing fluoroscopy (IFC), and 42 consecutive patients then underwent DAA THA without fluoroscopy (NFC). Using preoperative pelvis radiographs and 6-week postoperative pelvis radiographs, acetabular anteversion, inclination, femoral offset, and templated component sizes vs final intraoperatively selected sizes were recorded and compared between cohorts. Results: Acetabular inclination was 45.0 for IFC and 45.6 for NFC (P ¼ .629). Femoral offset difference preoperatively and postoperatively was 0.8 mm for IFC and 1.3 mm for NFC (P ¼ .734). Number of hips within the so-called safe zone was 32 for IFC and 33 for NFC (P ¼ .794). These all demonstrated no significant difference between the cohorts. However, acetabular anteversion was 13.7 for IFC and 11.2 for NFC (P ¼ .02). Conclusions: In this limited series, the routine use of intraoperative fluoroscopy did not improve implant positioning or sizing. This may be surgeon-specific or due to the result of the use of acetabular landmarks to guide placement of the components without fluoroscopy.

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Section: Introductionmentioning

confidence: 99%

Does the use of intraoperative fluoroscopy improve postoperative radiographic component positioning and implant size in total hip arthroplasty utilizing a direct anterior approach?

et al. 2020

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“…22 McArthur et al looked at radiation levels in 51 primary total hip arthroplasty and found that the average fluoroscopic time was 0.59 minutes. 21 Other studies showed that patient radiation levels were between 1.78-3 mGy. Though Comparing Postoperative Leg Length Discrepancy and Femoral Offset Using Two Different Surgical Approaches for...…”

Section: Discussionmentioning

confidence: 98%

“…20 It has been shown previously that fluoroscopy use during the anterior approach can improve component positioning, notably acetabular cup position. 11,21,22 Hasegawa et al published a study using intraoperative fluoroscopy and a grid system without any preoperative templating and had no differences in offset or leg length greater than 10 mm. 12 Other techniques have been utilized, including using intraoperative fluoroscopic references to the contralateral side with a radiopaque line 23 as well as comparing an intraoperative radiograph to preoperative contralateral radiograph overlay.…”

Section: Discussionmentioning

confidence: 99%

Comparing Postoperative Leg Length Discrepancy and Femoral Offset Using Two Different Surgical Approaches for Hemiarthroplasty of the Hip

Layson

Coon

Sharma

et al. 2021

Spartan Medical Research Journal

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INTRODUCTION The direct anterior approach (DAA) and anterolateral approach (ALA) may be used for hip hemiarthroplasty (HHA) as a treatment for femoral neck fractures. The DAA often utilizes intraoperative fluoroscopy to determine leg length and offset, while the ALA traditionally utilizes an intraoperative clinical exam to determine offset and leg length. This study will evaluate two techniques: the “grid fluoroscopy [GF] technique” and the “intraoperative exam [IE] technique,” each performed by one of two separate surgeons, and compare each technique’s accuracy to restore leg length and femoral offset in a patient population that underwent HHA. METHODS Two investigators retrospectively reviewed charts of 208 randomly selected patients who had an HHA from either a DAA or ALA performed by two different surgeons for the treatment of femoral neck fractures. Postoperative AP pelvis radiographs were measured to determine offset and leg length compared with the non-operative extremity. Non-normal continuous variables were provided by median and interquartile range. Data were analyzed with the Mann-Whitney U test and Student’s t-test. RESULTS After inclusion and exclusion criteria, data were reviewed on 173 hemiarthroplasties. The mean age was 80.3 years (± 11.2 years). Of the surgical patients, 65.9% were female, and 70.9% identified their ethnicity as white. The DAA was used in 93 patients and ALA in 80 patients. Analysis comparing the two techniques demonstrated no statistically significant differences in median leg length between GF technique (1.02 IQR -0.1, 2.0 mm) and IE technique (1.25 IQR -2.4, 1.3 mm,) (p=0.67). There was also no statistically significant difference in offset between GF technique (1.3 IQR 0.2, 2.1 mm) and IE technique (0.6 IQR -2.7 mm, 3.2 mm) (p=0.13). However, a difference was found in mean length of surgery that was statistically significant. We found that the mean length of surgery for the IE technique was 74.8 ± 24.7 minutes versus the GF technique, which was 95.1 ± 23.0 minutes, (p<0.0001). DISCUSSION There was no significant difference between leg length and offset with the use of intraoperative fluoroscopy with DAA compared to no intraoperative imaging with ALA. Our study suggests that DAA and ALA are equally effective approaches for re-establishing symmetric leg length and offset in HHA for femoral neck fractures. In this study, the ALA had a shorter surgical time compared to DAA, potentially due to the utilization of intraoperative fluoroscopy for this particular technique during the DAA.

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“…The objective of this study was to quantify the intraoperative exposure level of surgeons and intraoperative fluoroscopy time and compared these between DAA-THA and osteosynthesis for proximal femoral fracture. Studies on radiation exposure in DAA-THA have been occasionally reported, but the detection method of the radiation exposure level varied and was not uniform (Table 3) [14][15][16][17]. Thus, we compared only the intraoperative fluoroscopy time.…”

Section: Discussionmentioning

confidence: 99%

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

Jinnai

Baba

et al. 2020

SICOT-J

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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.

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Radiation Exposure during Fluoroscopic Guided Direct Anterior Approach for Total Hip Arthroplasty

Cited by 25 publications

References 25 publications

Does the use of intraoperative fluoroscopy improve postoperative radiographic component positioning and implant size in total hip arthroplasty utilizing a direct anterior approach?

Does the use of intraoperative fluoroscopy improve postoperative radiographic component positioning and implant size in total hip arthroplasty utilizing a direct anterior approach?

Comparing Postoperative Leg Length Discrepancy and Femoral Offset Using Two Different Surgical Approaches for Hemiarthroplasty of the Hip

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

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