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Brush PL, Santana A, Toci GR, Slotkin E, Solomon M, Jones T, Saxena A. Surgeon Estimations of Acetabular Cup Orientation Using Intraoperative Fluoroscopic Imagining Are Unreliable. Arthroplast Today 2023; 20:101109. [PMID: 36938353 PMCID: PMC10018435 DOI: 10.1016/j.artd.2023.101109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/12/2022] [Accepted: 01/22/2023] [Indexed: 03/21/2023] Open
Abstract
Background Accurate acetabular cup orientation is associated with decreased revision rates and improved outcomes of primary total hip arthroplasty. This study assesses surgeon's ability to estimate both the acetabular component inclination and anteversion angles via intraoperative fluoroscopy (IF) images. Methods We surveyed orthopedic surgeons to estimate acetabular component inclination and anteversion based on 20 IF images of total hip arthroplasty through a direct anterior approach. Postoperative computed-tomography scans were used to calculate the true inclination and anteversion component angles. The absolute difference between the true and estimated values was calculated to determine the mean and standard deviation of the survey results. Interrater reliability was determined through interclass correlation coefficients. Results A majority of surgeons preferred the direct anterior approach (83.3%) and utilized IF during surgery (70%). Surgeons surveyed were on average 5.9° away from the true value of inclination (standard deviation = 4.7) and 8.8° away from the true value of anteversion (standard deviation = 6.0). Respondents were within 5° of both inclination and anteversion in 19.7% of cases, and within 10° in 57.3% of cases. All surgeons were determined to have poor reliability in estimating anteversion (interclass correlation coefficient < 0.5). Only 2 surgeons were determined to have moderate reliability when estimating inclination. Conclusions Surgeons, when solely relying on IF for the estimation of anteversion and inclination, are unreliable. Utilization of other techniques in conjunction with IF would improve observer reliability.
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Affiliation(s)
- Parker L. Brush
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
- Corresponding author. Rothman Orthopaedic Institute, 925 Chestnut Street, Philadelphia, PA, USA. Tel.: +1 316 993 3876.
| | - Adrian Santana
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Gregory R. Toci
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric Slotkin
- Orthopaedic Associates of Reading, Tower Health, Reading Hopsital, West Reading, PA, USA
| | - Michael Solomon
- Sydney Orthopaedic Specialists, Prince of Wales Private Hospital, Randwick, Australia
| | | | - Arjun Saxena
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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2
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Abstract
BACKGROUND The use of intraoperative fluoroscopy (IF) is common with direct anterior total hip arthroplasty (THA), however image distortion in IF may limit its usefulness. The supplementation of IF with an adjustable grid (AG) may provide consistently better accuracy in component placement. Therefore, the purpose of this study was to compare the accuracy, consistency, and surgical efficiency between IF only and AG supplementation. METHODS 2 cohorts were retrospectively evaluated, including 573 IF only patients and 211 AG patients having undergone unilateral THA between 2011 and 2018. Post-THA radiographic assessment was performed to evaluate the accuracy of component placement, with target placements for global hip offset (GHO) and leg-length differences (LLD) <10 mm and acetabular cup abduction of 45° (±10°). Accuracy and surgical efficiency were evaluated between groups and over time. RESULTS The AG group had a significant greater percentage of components placed within the target zone compared to IF only for GHO (99.5%, 92.7%, p < 0.001), LLD (99.1%, 96.5%, p = 0.039) and abduction (99.5%, 96.3%, p = 0.009), with no difference in fluoroscopic time (p = 0.973). Over time, accuracy was significantly different in IF group for GHO (p = 0.008) and abduction (p = 0.002) and trended toward significance for LLD (p = 0.055). There were no significant differences over time for the AG group. CONCLUSIONS The addition of an AG to IF significantly increased the accuracy of component placement during direct anterior THA. These results were consistent over 2 years of use and did not decrease surgical efficiency.
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Affiliation(s)
| | - Scott Nishioka
- Straub Medical Center, Bone and Joint Center, Honolulu, HI, USA
| | - Samantha N Andrews
- Straub Medical Center, Bone and Joint Center, Honolulu, HI, USA.,Department of Surgery, University of Hawai'i, Honolulu, HI, USA
| | - Kristin Mathews
- Straub Medical Center, Bone and Joint Center, Honolulu, HI, USA
| | - Cass K Nakasone
- Straub Medical Center, Bone and Joint Center, Honolulu, HI, USA.,Department of Surgery, University of Hawai'i, Honolulu, HI, USA
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3
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Kirchner GJ, Smith NP, Dunleavy ML, Nikkel LE. Intraoperative Imaging in Total Hip Arthroplasty Is Cost-Effective Regardless of Surgical Approach. J Arthroplasty 2022; 37:S803-S806. [PMID: 34998907 DOI: 10.1016/j.arth.2021.12.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/30/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Component positioning in total hip arthroplasty (THA) may be improved with utilization of intraoperative imaging. The purpose of this study is to determine if intraoperative imaging during THA is cost-effective. METHODS A break-even analysis was used as a model for cost-effectiveness, which incorporates cost of imaging (including direct charges and the additional time required for imaging), rate of revision surgery, and cost of revision surgery, yielding a final revision rate that needs to be achieved with use of intraoperative imaging in order for its use to be cost-effective. Absolute risk reduction (ARR) is determined by the difference between the initial revision rate and final revision rate. RESULTS At an anticipated institutional cost of $120 and requiring 4 additional minutes, intraoperative fluoroscopy would be cost-effective if the baseline rate of revision due to component mispositioning (0.62%) is reduced to 0.46%. Intraoperative flat plate radiographs ($127) are cost-effective at an ARR of 0.16%. Cost-effectiveness is achieved with lower ARR in the setting of lower imaging costs ($15, ARR 0.02%), and higher ARR with higher imaging costs ($225, ARR 0.29%). ARR for cost-effectiveness is independent of baseline revision rate, but varies with the cost of revision procedures. CONCLUSION At current revision rates for component malpositioning, only 1 revision among 400 THAs needs to be prevented for the utilization of fluoroscopy (or 1 in 385 THAs with flat plate imaging), to achieve cost-effectiveness.
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Affiliation(s)
- Gregory J Kirchner
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Nathan P Smith
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Mark L Dunleavy
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Lucas E Nikkel
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
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4
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Sasaki S, Takahashi M, Hayashi T, Morita Y, Namiki S, Itagaki S. Utility of X-ray and indocyanine green fluorescence imaging in detecting hepatocellular carcinoma dissemination on laparoscopic surgery: A case report. Mol Clin Oncol 2021; 15:259. [PMID: 34754446 PMCID: PMC8569299 DOI: 10.3892/mco.2021.2421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/02/2021] [Indexed: 11/05/2022] Open
Abstract
Indocyanine green (ICG) fluorescence imaging is useful for the intraoperative detection of the peritoneal dissemination of hepatocellular carcinoma (HCC). However, in laparoscopic surgery, disseminations cannot be accurately identified unless the camera lens is positioned close to the lesion. The present study describes a case of HCC dissemination in which the lesions were accurately identified by combining intraoperative fluoroscopy with ICG fluorescence imaging. A 76-year-old male was diagnosed with HCC dissemination. Computed tomography revealed a 9-mm disseminated nodule near the gallbladder. Although transarterial chemoembolization had also been used to treat this lesion, chemoembolization was technically difficult to perform. Therefore, a coil was placed around the lesion to serve as an intraoperative landmark for later laparoscopic resection. Given the potential difficulty of detecting the lesion during laparoscopic surgery, ICG fluorescence imaging was used to determine the approximate location of the dissemination. The lesion exhibited strong fluorescence, which facilitated its complete resection.
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Affiliation(s)
- Shu Sasaki
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu-shi, Tokyo 183-8524, Japan
| | - Makoto Takahashi
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu-shi, Tokyo 183-8524, Japan
| | - Tatsuya Hayashi
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu-shi, Tokyo 183-8524, Japan
| | - Yasuhiro Morita
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu-shi, Tokyo 183-8524, Japan
| | - Shin Namiki
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Fuchu-shi, Tokyo 183-8524, Japan
| | - Shingo Itagaki
- Department of Pathology, Tokyo Metropolitan Tama Medical Center, Fuchu-shi, Tokyo 183-8524, Japan
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5
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Banno S, Baba T, Tanabe H, Homma Y, Ochi H, Watari T, Kobayashi H, Kaneko K. Use of traction table did not increase complications in total hip arthroplasty through direct anterior approach performed by novice surgeon. J Orthop Surg (Hong Kong) 2021; 28:2309499020923093. [PMID: 32583712 DOI: 10.1177/2309499020923093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The purpose of this study was to investigate the surgical outcomes of total hip arthroplasty (THA) through direct anterior approach (DAA) performed by beginners by comparing the outcomes after the introduction of DAA-THA between using a normal operating table and a traction table. METHODS The total subjects were 200 patients, there were 120 cases from the introduction of three surgeons using a normal table and 80 cases from two surgeons using a traction table. The surgical procedure was standardized, and a surgeon skilled in DAA entered the operating room and instructed the novice surgeons of DAA in all cases. RESULTS The mean operative time was no significant difference between the two groups (p = 0.093). The difference in slope of the operative time was no significant difference between the two groups (p value = 0.089). The mean fluoroscopy time and the mean blood loss were significant difference between the two groups (p < 0.05). The difference in slope of the fluoroscopy time and blood loss were significant difference between the two groups (p < 0.05). There were no intraoperative complications and no reoperations for any reason. CONCLUSIONS At the facility with a surgeon skilled in DAA, the use of a traction table in DAA did not increase the complication rate compared with the use of a normal operating table when the exclusion criteria for DAA were set and surgery was performed using intraoperative fluoroscopy under supervision by a skilled surgeon.
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Affiliation(s)
- Sammy Banno
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroki Tanabe
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hironori Ochi
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Taiji Watari
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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6
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Nair S, Nambiar M, Pope A, Parkes M, De Jong K, Hau R. Intraoperative fluoroscopy alone versus routine post-operative X-rays in identifying return to theatre after fracture fixation. ANZ J Surg 2021; 91:392-397. [PMID: 33538096 DOI: 10.1111/ans.16610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Post-operative imaging aims to assess fracture reduction and fixation with better resolution than intraoperative fluoroscopy (IF). However, this routine practice may increase costs and delay the discharge of patients. The aim of this study is to assess the role of post-operative imaging in identifying patients that require a return to theatre following the use of IF. METHODS A retrospective cohort study was conducted in a single health network comprising of two hospitals over 1 year. All fracture fixations that required IF were included. Patients who had post-operative imaging were identified and complications requiring a return to theatre were obtained. Non-trauma patients and those who did not have IF were excluded. RESULTS A total of 1319 patients had IF. Of these patients, 1131 patients had post-operative radiographs within 7 days of their operation. In total, 12 patients (1.1%) returned to theatre as a result of a finding identified in their post-operative imaging. The calculated number of X-rays required to be taken to identify a complication was 94. The main reasons identified for these cases to require a return to theatre despite having had IF included: (i) insufficient quality/views of IF, (ii) loss of position/new injury occurring in post-operative period and (iii) poor reduction/fixation demonstrated intraoperatively that was missed/accepted. CONCLUSION The use of post-operative radiographs can identify significant complications despite the use of IF in trauma patients. However, further consideration needs to be made regarding the benefits and costs of this practice in evaluating its clinical effectiveness.
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Affiliation(s)
- Sachin Nair
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Mithun Nambiar
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Alun Pope
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Muhajir Parkes
- Department of Radiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Kenneth De Jong
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Northwest Clinical School, Northern Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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7
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Kerschbaum M, Lang S, Baumann F, Alt V, Worlicek M. Two-Dimensional Visualization of the Three-Dimensional Planned Sacroiliac Screw Corridor with the Slice Fusion Method. J Clin Med 2021; 10:jcm10020184. [PMID: 33419193 PMCID: PMC7825576 DOI: 10.3390/jcm10020184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/03/2022] Open
Abstract
Insertion of sacro-iliac (SI) screws for stabilization of the posterior pelvic ring without intraoperative navigation or three-dimensional imaging can be challenging. The aim of this study was to develop a simple method to visualize the ideal SI screw corridor, on lateral two-dimensional images, corresponding to the lateral fluoroscopic view, used intraoperatively while screw insertion, to prevent neurovascular injury. We used multiplanar reconstructions of pre- and postoperative computed tomography scans (CT) to determine the position of the SI corridor. Then, we processed the dataset into a lateral two-dimensional slice fusion image (SFI) matching head and tip of the screw. Comparison of the preoperative SFI planning and the screw position in the postoperative SFI showed reproducible results. In conclusion, the slice fusion method is a simple technique for translation of three-dimensional planned SI screw positioning into a two-dimensional strict lateral fluoroscopic-like view.
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8
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Thorne TJ, Nishioka ST, Andrews SN, Mathews KA, Nakasone CK. Comparison of Component Placement Accuracy Using Two Intraoperative Fluoroscopic Grid Technologies During Direct Anterior Total Hip Arthroplasty. J Arthroplasty 2020; 35:3601-3606. [PMID: 32680756 DOI: 10.1016/j.arth.2020.06.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Intraoperative fluoroscopy is beneficial when performing total hip arthroplasty (THA) via the direct anterior approach; however, image distortion may influence component placement. A manual gridding system (MGS) and a digital gridding system (DGS) are commercially available, aimed at visually representing or correcting image distortion. Therefore, the purpose of this study is to compare component placement accuracy following direct anterior approach THA when intraoperative fluoroscopy was supplemented with MGS or DGS. METHODS A retrospective evaluation of acetabular cup abduction (ABD), leg length discrepancy (LLD) and global hip offset difference (GHO) was completed for consecutive patients from 6 week post-THA weight-bearing radiographs. The predefined target LLD and GHO was <10 mm and ABD target was 45° ± 10°. Differences between MGS and DGS were determined by independent t-tests. RESULTS The MGS (250 patients, 315 hips) and DGS (183 patients, 218 hips) achieved targeted ABD in 98.7% and 96.8% of cases, respectively, and ABD was significantly lower in the MGS group (45.14 ± 4.03° and 47.01 ± 4.39°, respectively) (P < .001). Compared to MGS, the DGS group averaged significantly higher GHO (3.64 ± 2.44 and 4.45 ± 2.73 mm, respectively, P = .002) but was not significantly different regarding LLD (2.92 ± 2.55 and 3.19 ± 2.46 mm, respectively, P = .275). No significant group difference was noted for percentage within the targeted LLD and GHO; however, 93.5% of DGS and 97.6% of MGS achieved all three (P = .031). CONCLUSION The use of both the MGS and DGS resulted in consistent component placement within the predefined target zone. Although the MGS appeared to be slightly more consistent, these differences are unlikely to be clinically significant.
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Affiliation(s)
| | | | - Samantha N Andrews
- Bone and Joint Center, Straub Medical Center, Honolulu, HI; Department of Surgery, University of Hawai'i, Honolulu, HI
| | | | - Cass K Nakasone
- Bone and Joint Center, Straub Medical Center, Honolulu, HI; Department of Surgery, University of Hawai'i, Honolulu, HI
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9
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Zhu D, Zhang Z, Zhang J, Chen D, Shan Y, Xie B, Liu P, Yan L. The efficacy of 3D printing-assisted surgery in treating distal radius fractures: systematic review and meta-analysis. J Comp Eff Res 2020; 9:919-931. [PMID: 32969712 DOI: 10.2217/cer-2020-0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare the efficacy of 3D printing-assisted surgery with routine surgery in the treatment of distal radius fractures to evaluate whether 3D printing technology has more advantages. Materials & methods: To retrieve all published studies that compared the efficacy of 3D printing-assisted surgery with routine surgery for distal radius fractures. Operation time, frequency of intraoperative fluoroscopy, blood loss and other outcomes were assessed. Results: The results suggested that 3D printing-assisted surgery was better than routine surgery in the fields of operation time, frequency of intraoperative fluoroscopy, and blood loss. Conclusion: In the treatment of distal radius fractures, 3D printing-assisted surgery may be superior to routine surgery.
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Affiliation(s)
- Dongming Zhu
- Department of Orthopedics, Dalian Medical University, Dalian 116044, China
| | - Zhen Zhang
- Department of Orthopedics, Dalian Medical University, Dalian 116044, China
| | - Jie Zhang
- Department of Orthopedics, Xiangya Second Hospital, Central South University, Changsha 410012, Hunan, China
| | - Duoyun Chen
- Department of Orthopedics, Dalian Medical University, Dalian 116044, China
| | - Yuzhou Shan
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou 225001, China
| | - Bin Xie
- Department of Orthopedics, Dalian Medical University, Dalian 116044, China
| | - Pengran Liu
- Department of Orthopedics, Xiangya Second Hospital, Central South University, Changsha 410012, Hunan, China
| | - Lianqi Yan
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou 225001, China
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Hajiha M, Smith J, Amasyali AS, Groegler J, Shah M, Alsyouf M, Krause A, You H, Brown J, Li A, Goyne A, Baldwin DD, Stokes P, Hsi R, Baldwin DD. The Effect of Operative Field Instrument Clutter During Intraoperative Fluoroscopy on Radiation Exposure. J Endourol 2019; 33:626-633. [PMID: 31088307 DOI: 10.1089/end.2019.0285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction and Objectives: Fluoroscopy units are routinely operated in the automatic brightness control (ABC) mode to optimize image quality. During ureteroscopy, objects may be placed within the fluoroscopy beam and the effect upon radiation exposure is unknown. The purpose of this study is to investigate the effects of equipment within the fluoroscopy beam during simulated ureteroscopy. Methods: ABC fluoroscopy of a cadaver was performed in eight clinical scenarios, including a control (no equipment), and seven groups with different equipment within the fluoroscopy beam. Equipment tested included electrocardiogram (EKG) leads, a Kelly clamp, camera and light cords (straight and coiled configurations), flexible ureteroscope, rigid cystoscope, and the lateral table support beam. Ten 145-second fluoroscopy trials were performed for each arm. The primary outcome was radiation dose (mGy) compared using the Mann-Whitney test with p < 0.05 considered significant. Results: Compared with control (18.5 mGy), radiation exposure was significantly increased with the presence of a straight camera and light cords (19.3 mGy), Kelly clamp (19.4 mGy), coiled camera and light cords (20.2 mGy), a flexible ureteroscope (21.0 mGy), a rigid cystoscope (21.2 mGy), and when the lateral table support beam was in the path of the X-ray (25.0 mGy; a 35% increase; p < 0.007 for all). The EKG leads did not affect the radiation dose. Conclusions: Avoiding equipment within the fluoroscopy beam using ABC mode can reduce radiation exposure. Adjusting the table and patient position to exclude the lateral table support beam will reduce radiation exposure by 35%.
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Affiliation(s)
- Mohammad Hajiha
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - John Smith
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - Akin S Amasyali
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - Jason Groegler
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - Milan Shah
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - Muhannad Alsyouf
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - Andrew Krause
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - Hyelin You
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - Jeremy Brown
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - Ashley Li
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - Arthur Goyne
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - D Daniel Baldwin
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - Phillip Stokes
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
| | - Ryan Hsi
- 2Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - D Duane Baldwin
- 1Department of Urology, Loma Linda University Health System, Loma Linda, California
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11
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Bingham JS, Spangehl MJ, Hines JT, Taunton MJ, Schwartz AJ. Does Intraoperative Fluoroscopy Improve Limb-Length Discrepancy and Acetabular Component Positioning During Direct Anterior Total Hip Arthroplasty? J Arthroplasty 2018; 33:2927-2931. [PMID: 29853308 DOI: 10.1016/j.arth.2018.05.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/27/2018] [Accepted: 05/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND One potential benefit of the direct anterior approach (DAA) for total hip arthroplasty is the ability to use intraoperative fluoroscopy for acetabular cup positioning and limb-length evaluation. Previous studies comparing the use of fluoroscopy with an anterior approach to a posterior approach have reported conflicting results. To our knowledge, no prior study has compared acetabular cup position and limb-length discrepancy (LLD) using a DAA with and without fluoroscopy. METHODS We retrospectively reviewed the charts of 298 patients who underwent direct anterior total hip arthroplasty with or without intraoperative fluoroscopy. All procedures were performed by 2 surgeons who use DAA as their primary approach. Preoperative and 6-week postoperative low anteroposterior pelvis and cross-table lateral radiographs were reviewed by 3 independent surgeons. Acetabular cup inclination, anteversion, and LLD were measured and compared. RESULTS Thirty-three patients were excluded for inadequate imaging, leaving 125 patients in the fluoroscopy group and 140 patients in the nonfluoroscopy group. Mean inclination, anteversion, and LLD were 39.4° (95% confidence interval [CI], 38.5°-40.2°), 30.2° (95% CI, 29.2°-31.2°), and 1.1 mm (95% CI, 0.1 mm-2.2 mm) for the fluoroscopy group and 39.9° (95% CI, 39.3°-40.5°), 31.1° (95% CI, 30.0°-32.2°), and 0.8 mm (95% CI, -0.1 mm to 1.6 mm) for the nonfluoroscopy group. There was no significant difference in acetabular inclination (P = .35), anteversion (P = .22), or postoperative LLD (P = .64) between groups. CONCLUSION This study found no clinically or statistically significant difference in acetabular inclination, anteversion, or LLD between the fluoroscopy and nonfluoroscopy groups. Both surgeons achieved a similar mean acetabular cup position and an equivalent mean LLD.
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Affiliation(s)
| | | | - Jeremy T Hines
- Orthopaedic Department, Mayo Clinic, Rochester, Minnesota
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12
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Yamaguchi N, Hiramatsu K, Shibata Y, Yoshihara M, Aoba T, Kamiya T, Koike Y, Fujita T, Maeda C, Ito K, Kanbara Y, Nishimura M, Kobayashi R, Dei H, Takimoto A, Nonaka Y, Kato T. Sewing needles in the abdominal cavity assumed to have been ingested and to have penetrated the GI tract 40 years ago: A case report. Asian J Endosc Surg 2017; 10:446-449. [PMID: 28349649 DOI: 10.1111/ases.12375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 02/27/2017] [Indexed: 11/29/2022]
Abstract
A 60-year old woman had been hospitalized in a psychiatric hospital for 40 years for schizophrenia. An X-ray was performed when she fell, which showed needles in the abdominal field. After additional examinations and questioning, the patient was diagnosed with needles in the abdominal cavity, which were assumed to have been ingested and to have perforated the GI tract 40 years ago. They were removed by laparoscopic surgery. The needles were found in the omentum and near the left ovary. There were no inflammatory reactions around them. There have been previous reports about the removal of intra-abdominal foreign bodies, but foreign body reaction occurred in most of the reports. Our case had the longest period from ingestion of the foreign bodies to their removal. Laparoscopy and intraoperative fluoroscopy are useful for removing intra-abdominal foreign bodies because of their ability to help discriminate between structures and to navigate in real time.
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Affiliation(s)
- Naoya Yamaguchi
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Kazuhiro Hiramatsu
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yoshihisa Shibata
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Motoi Yoshihara
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Taro Aoba
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Tadahiro Kamiya
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yoshio Koike
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Takeru Fujita
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Chikara Maeda
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Kisuke Ito
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yuichi Kanbara
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Motonobu Nishimura
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Ryutarou Kobayashi
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Hideyuki Dei
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Aitaro Takimoto
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yukiko Nonaka
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Takehito Kato
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
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13
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Kawachi J, Kashiwagi H, Ogino H, Isogai N, Shimoyama R, Fukai R, Miyake K, Sasaki A, Terashima T, Teshima S, Watanabe K. Stomach resection with intraoperative fluoroscopy in laparoscopic distal gastrectomy for early gastric cancer. J Minim Access Surg 2017; 14:236-240. [PMID: 29067944 PMCID: PMC6001300 DOI: 10.4103/jmas.jmas_61_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: In Japan, laparoscopic distal gastrectomy (LDG) is common for early gastric cancer. Formerly, we used to verify the location of the marking clip to decide the proximal incisional line with our hand, through a small epigastric incision. In 2015, we introduced intracorporeal reconstruction and started to decide the incisional line using intraoperative fluoroscopy. Herein, we aimed to evaluate the efficacy and safety of intraoperative fluoroscopy in LDG. Patients and Methods: A total of 19 patients were included in this retrospective observational study. On the day before operation, we endoscopically clipped several points located 2 cm proximal to the tumour edge to cover about half of the tumour. After lymph node dissection, we incised the stomach with an endoscopic linear stapling device, including the previously placed clips, guided by intraoperative fluoroscopy. Reconstruction was performed in all patients who underwent Billroth I and Roux-en-Y procedures. Results: No complications were observed during pre-operative endoscopic clipping or intraoperatively. On pathological examination, all resected specimens had negative margins, and the mean distance from the tumour edge was 28.5 ± 16.5 (13–60) mm. Conclusion: Stomach resection with intraoperative fluoroscopic guidance was safe and effective.
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Affiliation(s)
- Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroyuki Kashiwagi
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ryuta Fukai
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Katsunori Miyake
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Akiko Sasaki
- Gastroenterology Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Shinichi Teshima
- Department of Pathology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kazunao Watanabe
- Department of Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
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14
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Boettner F, Zingg M, Emara AK, Waldstein W, Faschingbauer M, Kasparek MF. The Accuracy of Acetabular Component Position Using a Novel Method to Determine Anteversion. J Arthroplasty 2017; 32:1180-1185. [PMID: 27839959 DOI: 10.1016/j.arth.2016.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/19/2016] [Accepted: 10/03/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study compares the differences in acetabular component position, leg length discrepancy, and hip offset between the anterior and posterior approach. A novel method is applied to determine the acetabular anteversion using the C-arm tilt angle for the anterior approach. METHODS Hundred consecutive anterior total hip arthroplasties were matched according to gender, body mass index, and age to a cohort of 100 primary total hip arthroplasties operated on through a posterior approach. Postoperative radiographs were analyzed to determine cup inclination, cup anteversion, leg length discrepancy, and hip offset. RESULTS The mean inclination was 40.8° (range 33°-48°) and 45.1° (range 33°-55°) for the anterior and posterior approach, respectively. Using the new C-arm tilt plane technique, an average acetabular anteversion of 18.4° (range 11°-26°) was achieved with the anterior approach compared with 23.6° (range 8°-38°) with the posterior approach. Hundred percent cups in the anterior group and 81% in the posterior group fell within the safe zone (P < .001). There was no difference in the overall hip offset between the operated side and the contralateral side for the anterior (P = .074) and posterior (P = .919) group. There was no difference in leg length discrepancy between the 2 approaches (P = .259). CONCLUSION Intraoperative fluoroscopy-assisted direct anterior approach was associated with improved acetabular component positioning. However, no benefit was shown with regards to restoration of hip offset or leg length.
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Affiliation(s)
- Friedrich Boettner
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Matthieu Zingg
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Genève 14, Switzerland
| | - Ahmed K Emara
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Wenzel Waldstein
- Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | | | - Maximilian F Kasparek
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York
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