Occupational Hazards to the Joint Replacement Surgeon: Radiation Exposure

Daryoush, Joshua; Lancaster, Alex; Frandsen, Jonathan; Gililland, Jeremy M.

doi:10.1016/j.arth.2022.02.095

Cited by 9 publications

(7 citation statements)

References 33 publications

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“…The present study showed that the use of intraoperative imaging lengthens operation duration, which may be attributable only to the radiographic control itself or to the above-mentioned intraoperative adaptations. This exposes to radiation both the surgical team and the patient [7] and causes significant added costs [6]. These disadvantages may be acceptable under the condition that the patient benefits from them.…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

“…To date, it remains unclear whether the benefit of intraoperative fluoroscopic control of the component position outweighs the potential disadvantages related to its use (longer operation times, higher costs and radiation exposure) [6,7]. Individual studies either failed to show a significant difference or found only small differences [8][9][10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative imaging in hip arthroplasty: a meta-analysis and systematic review of randomized controlled trials and observational studies

et al. 2023

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Background Intraoperative fluoroscopy (IFC) is gaining popularity in total hip arthroplasty (THA), with the aim to achieve better component positioning and therefore eventually reduced revision rates. This meta-analysis investigated the benefit of IFC by comparing it to intraoperative assessment alone. The primary outcome was component positioning and the secondary outcomes included complications and revision rates. Methods PubMed, Embase and Cochrane Central Register of Controlled Trials were searched for both randomized clinical trials (RCT) and observational studies. Effect estimates for radiographic cup position, offset/leg length difference and outliers from a safe zone were pooled across studies using random effects models and presented as a weighted odds ratio (OR) with a corresponding 95% confidence interval (95% CI). Results A total of 10 observational studies involving 1,394 patients were included. No randomized trials were found. IFC showed no significant reduction in acetabular cup position (inclination and anteversion), offset, leg-length discrepancies, revision (none reported) or overall complication rates. Conclusion The current meta-analysis found no differences in cup positioning, offset, leg length discrepancy, the incidence of complications or revision surgery. It should be acknowledged that the included studies were generally performed by experienced surgeons. The benefit of intraoperative fluoroscopy might become more evident at an early phase of the learning curve for this procedure. Therefore, its role has yet to be defined.

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Section: Interpretation Of Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intraoperative imaging in hip arthroplasty: a meta-analysis and systematic review of randomized controlled trials and observational studies

et al. 2023

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“…Although the included studies did not discuss the benefits of fluoroscopy for surgeons with less experience or surgeons in lower-volume hospitals, this group of surgeons is expected to benefit more from intraoperative fluoroscopy. However, there are also potential disadvantages related to its use, including the extra time required to get the images, higher costs, radiation exposure for both the patient and surgical team, and some worry that the sterile fluoroscopy arm covering may become contaminated during the operation [ 33 – 38 ]. If the patient benefits from these drawbacks, these disadvantages may be acceptable.…”

Section: Discussionmentioning

confidence: 99%

Does intraoperative fluoroscopy improve acetabular component positioning and limb-length discrepancy during direct anterior total hip arthroplasty? A meta-analysis

Sun

Lee²,

et al. 2023

J Orthop Surg Res

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Background The positioning of implant components for total hip arthroplasty (THA) is essential for joint stability, polyethylene liner wear, and range of motion. One potential benefit of the direct anterior approach (DAA) for THA is the ability to use intraoperative fluoroscopy for acetabular cup positioning and limb-length evaluation. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during DAA have reported conflicting results. This meta-analysis aimed to evaluate whether intraoperative fluoroscopy improves component positioning compared to no fluoroscopy during direct anterior total hip arthroplasty. Methods A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched Web of Science, EMBASE, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving intraoperative fluoroscopy versus no fluoroscopy during direct anterior total hip arthroplasty. Finally, we identified 1262 hips assessed in seven studies. Results There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.21), ACIA within safe zone rate (P = 0.97), acetabular cup anteversion angle (ACAA, P = 0.26); ACAA within safe zone rate (P = 0.07), combined safe zone rate (P = 0.33), and limb-length discrepancy (LLD, P = 0.21) between two groups. Conclusion Even though intraoperative fluoroscopy was not related to an improvement in cup location or LDD. With fewer experienced surgeons, the benefit of intraoperative fluoroscopy might become more evident. More adequately powered and well-designed long-term follow-up studies were required to determine whether the application of the intraoperative fluoroscopy for direct anterior total hip arthroplasty will have clinical benefits and improve the survival of prostheses.

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“…This risk is though to be related to the total ionised radiation from fluoroscopy used in all operations (20). It should therefore be a basic aim to minimise the lifetime cumulative radiation exposure of surgeons and the associated risks that can develop (23). Appropriate fluoroscopy safety precautions must be followed such as wearing suitable protective equipment, reducing the duration of fluoroscopy, and keeping the greatest distance from the radiation source (23,24).…”

Section: Discussionmentioning

confidence: 99%

“…It should therefore be a basic aim to minimise the lifetime cumulative radiation exposure of surgeons and the associated risks that can develop (23). Appropriate fluoroscopy safety precautions must be followed such as wearing suitable protective equipment, reducing the duration of fluoroscopy, and keeping the greatest distance from the radiation source (23,24). Following the standard safety precautions will enable the surgical team to be exposed to the minimum level of radiation and be within permissible limits (24,25).…”

Section: Discussionmentioning

confidence: 99%

Which of the three different intramedullary nail designs is superior in the treatment of femoral shaft fractures?

Alıç

GÜLER²,

ÇALBIYIK>

et al. 2023

Journal of Health Sciences and Medicine

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Aim: The aim of this study a retrospective comparison was the clinical and radiological results results of patients with femoral shaft fracture made oftreated with three different types of intramedullary nail (IMN). Material and Method: The study included 54 patients operated on in our clinic because of femoral shaft fracture. The records were retrospectively examined of 18 patients applied with locked IMN (LIMN), 17 with blade expandable IMN (BEIMN), and 19 with talon distalfix IMN (TDIMN). The groups were compared statistically in respect of age, gender, BMI, affected side, operating time (mins), radiation exposure (number of shots), time to union (weeks), visual analog scale (VAS) score, soft tissue problems associated with implant irritation, amount of shortening (mm), coronal, sagittal and torsional angulation (degrees). Results: The mean VAS score of the TDIMN group was determined to be statistically significantly higher than that of the LIMN and BEIMN groups (p=0.008, p=0.045). The operating times were similar in the BEIN and TDIMN groups (p=0.768) and significantly shorter than in the LIMN group (p

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Occupational Hazards to the Joint Replacement Surgeon: Radiation Exposure

Cited by 9 publications

References 33 publications

Intraoperative imaging in hip arthroplasty: a meta-analysis and systematic review of randomized controlled trials and observational studies

Intraoperative imaging in hip arthroplasty: a meta-analysis and systematic review of randomized controlled trials and observational studies

Does intraoperative fluoroscopy improve acetabular component positioning and limb-length discrepancy during direct anterior total hip arthroplasty? A meta-analysis

Which of the three different intramedullary nail designs is superior in the treatment of femoral shaft fractures?

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