Use of the flat panel detector fluoroscope reduces radiation exposure during periacetabular osteotomy.

The Periacetabular Osteotomy is a technically demanding procedure that requires precise intraoperative evaluation of pelvic anatomy. Fluoroscopic images pose a radiation risk to operating room staff, scrubbed personnel, and the patient. Most commonly, a Standard Fluoroscope with an Image Intensifier is used. Our institution recently implemented the novel Fluoroscope with a Flat Panel Detector. The purpose of this study was to compare radiation dosage and accuracy between the two fluoroscopes. A retrospective review of a consecutive series of patients who underwent Periacetabular Osteotomy for symptomatic hip dysplasia was completed. The total radiation exposure dose (mGy) was recorded and compared for each case from the standard fluoroscope (n = 27) and the flat panel detector (n = 26) cohorts. Lateral center edge angle was measured and compared intraoperatively and at the six-week postoperative visit. A total of 53 patients (96% female) with a mean age and BMI of 17.84 (± 6.84) years and 22.66 (± 4.49) kg/m2 (standard fluoroscope) and 18.23 (± 4.21) years and 21.99 (± 4.00) kg/m2 (flat panel detector) were included. The standard fluoroscope averaged total radiation exposure to be 410.61(± 193.02) mGy, while the flat panel detector averaged 91.12 (± 49.64) mGy (p < 0.0001). The average difference (bias) between intraoperative and 6-week postoperative lateral center edge angle measurement was 0.36° (limits of agreement: - 3.19 to 2.47°) for the standard fluoroscope and 0.27° (limits of agreement: - 2.05 to 2.59°) for the flat panel detector cohort. Use of fluoroscopy with flat panel detector technology decreased the total radiation dose exposure intraoperatively and produced an equivalent assessment of intraoperative lateral center edge angle. Decreasing radiation exposure to young patients is imperative to reduce the risk of future comorbidities.

The Optimal Age for Surgical Management of DDH Differs by Treatment Method.

BACKGROUND: There is a lack of consensus on the optimal age for specific surgical interventions for developmental dysplasia of the hip. We compared radiographic and clinical outcomes among patients who were treated with closed reduction (CR), open reduction (OR), and open reduction with concomitant pelvic osteotomy (ORP) for the treatment of a dislocated hip. We sought to identify the optimal age at treatment within each of these groups. METHODS: We retrospectively reviewed 256 hips (n=195 patients) who underwent CR (n=96), OR (n=116), or an ORP (n=44) as their index procedure at a single institution between January 1, 2004 and September 23, 2020. Radiographic outcomes included acetabular index, The International Hip Dysplasia Institute classification, and acetabular depth ratio. The incidence of further corrective surgery (FCS), defined as the need for an additional femoral and/or pelvic osteotomy before skeletal maturity, and the optimal age cutoffs for index surgery within each surgical group were determined. RESULTS: After adjusting for age and sex, the incidence of FCS was 13.8% in the CR group, 29.2% in the OR group, and 9.2% in the ORP group. Earlier surgery was protective against FCS in the CR and OR groups. In contrast, patients in the ORP group who were older at index procedure were less likely to undergo FCS. Optimal age at surgery was 9.9 months (CR), 11.5 months (OR), and 21.4 months (ORP). Compared with older patients, younger patients were associated with a larger average decrease in the acetabular index and a larger average increase in acetabular width during the first 5 years post surgery. CONCLUSIONS: Age at index surgical procedure was correlated with both clinical and radiographic outcomes. Age at index procedure did impact the risk of subsequent FCS, particularly in the CR and ORP groups. Based on our analysis, CR should be considered before 9.9 months of age and OR considered before 11.5 months of age to minimize the risk of FCS during childhood. This work highlights the importance of considering age-related heterogeneity in developmental dysplasia of the hip treatment outcomes. LEVEL OF EVIDENCE: Level III-retrospective comparative study.