Intraoperative Radiation Exposure with Percutaneous vs Hybrid Hallux Valgus Correction: A Comparative Study.

Area of Science:

• Orthopedic Surgery
• Radiological Safety
• Minimally Invasive Techniques

Background:

• Minimally invasive surgery (MIS) for hallux valgus (HV) is increasingly popular but raises concerns regarding fluoroscopy use and radiation exposure.
• Traditional open techniques for HV correction are being compared with newer MIS approaches.
• This study specifically addresses radiation exposure differences between percutaneous HV correction and a hybrid technique.

Purpose of the Study:

• To compare intraoperative radiation exposure between percutaneous HV correction and a hybrid technique using a mini C-arm.
• To evaluate dose-area product (DAP) and exposure duration for both surgical methods.
• To assess the cumulative radiation doses for patients and surgical teams against established safety thresholds.

Main Methods:

• A prospective study involving 68 patients undergoing HV correction from February 2022 to July 2023.
• Group 1: 37 patients (percutaneous chevron and Akin osteotomy).
• Group 2: 31 patients (hybrid technique: mini-open distal chevron osteotomy + percutaneous Akin osteotomy).
• Radiation exposure measured via DAP, exposure duration, and dosimeters for personnel and patients.

Main Results:

• Group 1 (percutaneous) showed significantly higher mean DAP (3.02 cGy/cm²) and exposure duration (56.74 seconds) compared to Group 2 (hybrid) (1.56 cGy/cm², 23.54 seconds).
• Despite increased use per case, cumulative radiation doses for both patients and surgical teams remained below International Commission on Radiological Protection (ICRP) safety limits.
• ICRP limits are 5 cGy for whole body/eye lens and 50 cGy for hand exposure.

Conclusions:

• Percutaneous hallux valgus correction involves greater intraoperative fluoroscopy time and radiation exposure.
• Radiation exposure remains within ICRP safety limits when using mini C-arm fluoroscopy.
• Percutaneous techniques are supported for use in appropriately selected hallux valgus patients.