2019 ISAKOS Biennial Congress ePoster #606
Intraoperative Radiation Exposure in Hip Arthroscopy: A Systematic Review
Ajay Shah, MD Cand., Hamilton, ON CANADA
Mohammed Nassri, MD, Hamilton, ON CANADA
Jeffrey Kay, MD, Toronto, ON CANADA
Nicole Simunovic, MSc, Hamilton, ON CANADA
Olufemi R. Ayeni, MD, PhD, MSc, FRCSC, Hamilton, ON CANADA
McMaster University, Hamilton, ON, CANADA
FDA Status Not Applicable
Summary
The purpose of the current systematic review was to assess intraoperative radiation exposure in hip arthroscopy, as fluoroscopy is used for portal placement, instrument localization, and guidance in bony resection and suture anchor placement.
Abstract
Background
Fluoroscopy is used in hip arthroscopy (HA) for portal placement, instrument localization, and guidance in bony resection and suture anchor placement. The purpose of the current systematic review was to assess intraoperative radiation exposure in HA.
Methods
The systematic review was conducted according to PRISMA guidelines. Three databases (Embase, Medline, Web of Science) were searched on April 18, 2018.
Results
Nine articles (eight retrospective cohort studies and one randomized-controlled trial) comprising 994 patients (470 male, 436 female, 169 unknown) with mean age 38.6 (14-77) years were included. Mean fluoroscopy time in 697 procedures was 0.58 (0.01-2.10) minutes. Eight studies reported on cumulative radiation dose relating to deterministic effects (acute skin injury, radiation sickness). Mean dose area product was 129.5 cGycm2 (n=207). Mean intraoperative radiation dose was 12.6 mGy (n=318). More radiation was used in procedures requiring osteoplasty than non-osteoplasty (n=69, p=0.005). Six studies reported on stoachistic effects, which represents the long-term risk from multiple low dose exposures. Mean intraoperative effective dose was 0.48 mSv (n=271), compared to CT (2.35 mSv) and plain film (3.50 mSv) effective doses (n=52). The intraoperative effective dose corresponds to a 0.0024% increased risk of fatal carcinogenesis. Mean occupational exposure to the surgeon per case was 0.051 mSv (n=261). Higher BMI correlated to greater intraoperative effective dose (p<0.05, r=0.40), cumulative dose (p<0.001, r=0.46), and occupational exposure. Increasing surgeon experience decreased fluoroscopy time (p = 0.039) and radiation dose (p = 0.002).
Conclusions
Cumulative radiation dose (12.6 mGy) was well under the 2 Gy threshold for deterministic effects (skin erythema). Effective dose to the patient (0.48 mSv) was comparable to natural background radiation for 50 days.