Flat Panel Detector Fluoroscopy Reduces Radiation Exposure in PAO Surgery

Research study background

Periacetabular Osteotomy (PAO) is a complex procedure that corrects symptomatic developmental dysplasia of the hip (DDH). Intraoperative fluoroscopy allows for visualization of the entire pelvis and acetabulum, but its use exposes the patient and operating room staff to harmful radiation.

Surgical teams have primarily relied on standard fluoroscopy with an image intensifier (SFII), which converts X-rays into video images, to navigate the patient’s pelvic anatomy. In recent years, Children’s Hospital Colorado implemented flat panel detector (FPD) fluoroscope, a newer technology that offers more efficient image conversion to electronic data, higher resolution, fewer distortions and a smaller and more mobile design. For a number of pediatric procedures, FPD has reduced radiation exposure and improved navigational accuracy, but it has not been studied in hip preservation.

In this study, researchers in the Orthopedics Institute at Children’s Colorado compared SFII and FPD to identify the best method to minimize radiation exposure during PAO surgery. Fifty-three patients, mostly female, who underwent PAO between January 2019 and August 2020 were retrospectively reviewed and grouped by the type of fluoroscopy used. Study authors measured the total radiation exposure as well as the accuracy of lateral center edge angle images produced intraoperatively and at the six-week postoperative visit.

Compared to SFII, FPD reduced the total radiation dose by 78% and the radiation exposure time by 59%. Surgical time was also significantly reduced in the FPD group, which led to a significant decrease in the average radiation exposure time per surgical hour.

Additionally, when the accuracy of the images produced were compared, the mean difference between the lateral center edge angle measurements was minimal.

Clinical implications

These findings suggest that FPD can reduce direct radiation exposure — including exposure time, dose and dose rate — during PAO, while maintaining a similar quality of surgical correction compared to the previous standard of care.

Future studies should examine FPD for long-term effects after PAO surgery and the difference between FPD and SFII for other predictors of outcomes such as accuracy of anterior center-edge angle measurement.