Fluoroscopic Intraoperative Images Produce Higher Image Quality and Decrease Total Radiation Exposure Compared to Radiographic X-ray Images in Patients After Primary Total Knee Arthroplasty.

Abstract

Proper radiographic documentation of implant alignment is needed to analyse malrotation and malpositioning. We examined whether intraoperative fluoroscopic images can achieve more accurate image quality than postoperative radiographic X-ray images. We prospectively analysed 30 consecutive patients after total knee arthroplasty (TKA). We compared intraoperative fluoroscopic images with postoperative radiographic X-ray images. Radiation exposure was documented. Fluoroscopic anterior-posterior images could achieve accurate image quality in 77% compared to 60% in radiographic images (p=0.016) and 54% compared to 34% on lateral view, respectively (p=0.008). Very good intra-observer correlation for fluoroscopic images could be achieved for femoral α angle with 0.84. Radiation exposure was 0.087+/-0.128 mGy. We observed significantly better image quality in fluoroscopic images than in radiographic X-ray images. The observed radiation exposure is lower than those expected for radiographic X-ray images. We conclude that fluoroscopic images can produce higher image quality and decreased radiation exposure.