Fluoroscopy cannot recognize intraoperative fracture in patients receiving 2-incision total hip arthroplasty.
Intraoperative fluoroscopy is suggested as a standard procedure in 2-incision total hip arthroplasty. Between September 2003 and July 2004, 2-incision total hip arthroplasties were done in 18 hips with and another 18 hips without the use of fluoroscopy. In group 1, the anterior skin incision was initially limited to 5 cm. Fracture or instability was checked by fluoroscopy first and then the incision was enlarged to 8 cm for visualization. In group 2, incisions were made long enough to expose the surgical field. There were 2 femoral neck fractures in the fluoroscopy group. The fractures were linear in the anteromedial femoral neck and could not be detected by fluoroscopy. Such linear fractures if overlooked could result in serious complications such as fracture displacement or implant instability. Surgeons should not rely on intraoperative fluoroscopy to check implant stability, and visualization of the surgical field should not be compromised when doing minimally invasive approach for total hip arthroplasty.
Department of Orthopaedics, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan.
Chih-Chien
CC
Hu
Wen-E
WE
Yang
Yu-Han
YH
Chang
Dave W
DW
Chen
Steve W
SW
Ueng
Mel S
MS
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D005471:Fluoroscopy; D006622:Hip Prosthesis; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging; D008297:Male; D015207:Osteoarthritis, Hip / Q000601:surgery; D011446:Prospective Studies