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Intraoperative Guidance for the Surgical Correction of Cam Deformities Using Hip Arthroscopy Based on Alpha Angle Measurement.

ABSTRACT: Residual femoroacetabular impingement syndrome due to incomplete resection of a cam deformity is the leading cause of failed hip arthroscopy. The reliability of the alpha angle has been shown for quantifying cam deformities in femoroacetabular impingement syndrome. An intraoperative navigation tool that provides the ability to compare alpha angle measurements side by side on pre- and post-resection fluoroscopic images has recently been introduced. This tool uses fluoroscopic images obtained in 6 different hip positions. The reliability of these standardized hip positions has been shown by correlation with computed tomography in localization and visualization of cam deformities. The purpose of this Technical Note is to give technical tips about the application of this tool.

SUBMITTER: Gursoy S

PROVIDER: S-EPMC8185893 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:The frequency of hip arthroscopy for the treatment of acute and chronic chondrolabral pathology and femoroacetabular impingement (FAI) has increased exponentially over the past decade. While surgeon and patient radiation exposure has been well documented in other areas of the orthopaedic literature, little is known about the procedure-specific and cumulative doses affecting the hip arthroscopist.To determine the mean annual radiation exposure to the hip arthroscopist and the mean surgeon exposure per case.Case series; Level of evidence, 4.A total of 210 consecutive hip arthroscopies performed in 209 patients by a single surgeon at a single ambulatory surgical center in a cohort consisting of approximately 50% bony (cam and pincer) pathology were prospectively reviewed, documenting the specific procedures performed in each case and the readings from a radiation dosimeter worn by the surgeon during positioning and while performing the procedures. Radiation readings for deep dose-equivalent (DDE), lens dose-equivalent (LDE), and shallow dose-equivalent (SDE) were measured. These readings were compared with the annual radiation dose limit recommendations established by the International Commission on Radiological Protection (ICRP).The total radiation doses for the operative surgeon during all 210 cases were 183 mrem (1.83 mSv) DDE, 183 mrem (1.83 mSv) LDE, and 176 mrem (1.76 mSv) SDE. The mean exposure per case was 0.871 mrem (0.00871 mSv) DDE, 0.871 mrem (0.00871 mSv) LDE, and 0.838 mrem (0.00838 mSv) SDE. The operative surgeon's mean annual exposure, performing 70 hip arthroscopies per year with 55% involving bony work, was 61.0 mrem (0.610 mSv) DDE, 61.0 mrem (0.610 mSv) LDE, and 58.7 mrem (0.587 mSv) SDE. These results are well below the ICRP annual limits of 50,000 mrem (500 mSv) DDE, 2000 mrem (20 mSv) LDE, and 50,000 mrem (500 mSv) SDE.For an experienced hip arthroscopist utilizing fluoroscopy during setup and bony resection, the annual and per-patient exposure to radiation remains well below the recommended ICRP limits.Considering the increasing annual frequency of hip arthroscopies being performed, information regarding procedure-specific and cumulative doses of radiation exposure affecting the hip arthroscopist may provide valuable safety information for the orthopaedic community.

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Intraoperative Guidance for the Surgical Correction of Cam Deformities Using Hip Arthroscopy Based on Alpha Angle Measurement.

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