Clinical feasibility of camera-type X-ray for intraoperative imaging of hip arthroplasty: a pilot study

To evaluate the clinical feasibility of a camera-type X-ray system, compared with conventional portable X-ray, for intraoperative imaging during hip arthroplasty.

Twenty-one patients who underwent hip arthroplasty were prospectively enrolled. Conventional portable and camera-type X-ray images were obtained intraoperatively (n = 42). Three reviewers (two radiologists and one orthopedic surgeon) independently assessed image quality and diagnostic confidence using 4-point Likert scales, as well as the feasibility of assessing leg length discrepancies (LLD), calculated as the difference between the transischial line and the lesser trochanter (TI-LT). Two radiologists also measured the TI-LT interval in both modalities. Image quality and diagnostic confidence were compared using the Wilcoxon rank-sum test. The feasibility of LLD assessment was analyzed using Fisher's exact test. The agreement between camera-type and portable X-ray measurements was evaluated using intraclass correlation coefficients (ICCs).

Image quality scores were significantly higher for portable X-rays than for camera-type X-rays (mean ± SD, 3.65 ± 0.44 vs. 2.57 ± 0.89; p < 0.001). Diagnostic confidence was also higher with the portable X-rays (3.86 ± 0.27 vs. 2.95 ± 0.91; p < 0.001). However, the feasibility of the LLD assessment did not differ significantly between the two modalities for any reviewer (all p > 0.1). The TI-LT interval measurements demonstrated good agreement between camera-type and portable X-rays, with an ICC of 0.750 (95% CI 0.454-0.898).

Although conventional portable X-rays provided superior image quality and diagnostic confidence, camera-type X-rays demonstrated comparable feasibility for intraoperative evaluation of LLD and good agreement in quantitative measurements. These findings support the clinical feasibility of using camera-type X-rays for intraoperative imaging during hip arthroplasty.