Intraoperative 3D Fluoroscopy During Open Reduction for DDH: An Effective Alternative to Postoperative CT/MRI

Area of Science:

• Orthopedic surgery
• Pediatric imaging
• Medical technology assessment

Background:

• Computed tomography (CT) and magnetic resonance imaging (MRI) are standard for assessing hip reduction post-open reduction (OR) for developmental dysplasia of the hip (DDH).
• Intraoperative 3D fluoroscopy (3D) was introduced as an alternative imaging modality in 2015.
• 3D allows for immediate surgical adjustments if hip reduction is insufficient.

Purpose of the Study:

• To compare the efficacy of intraoperative 3D fluoroscopy versus CT/MRI for assessing hip reduction in DDH after OR.
• To evaluate key clinical and imaging outcomes between the two modalities.

Main Methods:

• Retrospective comparative study of two consecutive cohorts: OR with 3D (2015-2017) and OR with CT/MRI (2012-2014).
• Evaluation of time to imaging, re-imaging, length of stay (LOS), re-operation, and redislocation/subluxation rates.
• Diagnostic study with Level II evidence.

Main Results:

• Intraoperative 3D imaging was performed on 46 hips, compared to 32 hips with CT/MRI.
• Significant improvements observed in 3D group for time to imaging, cast changes (2% vs 13%), and shorter mean LOS (1.72 vs 2.20 days).
• No significant differences in re-imaging, subluxations, or redislocations between the 3D and CT/MRI groups.

Conclusions:

• Intraoperative 3D fluoroscopy offers advantages in imaging timeliness and allows for immediate cast adjustments during surgery.
• Shorter LOS was achieved with 3D imaging compared to CT/MRI.
• 3D is a viable and effective alternative to CT/MRI for evaluating hip reduction in DDH after OR, with comparable safety outcomes.