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intra-operative imaging during surgery » hip surgery


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Intra-operative Imaging During Surgery

Improving the Accuracy of Total Hip Arthroplasty

In my hands, the intra-operative xray machine called the C arm or fluoroscope is a very useful tool for improving the accuracy of total hip arthroplasty.

Direct Anterior Approach

The direct anterior approach is well-suited to using a C-arm because the patient is flat on their back and it is very easy to image the pelvis.  The C-arm has been used for fracture surgery for a long period of time, but it is difficult to position the machine easily when the patient is lying on their side.  When the patient is in the supine position (flat on their back) I can use the C arm during all of the critical steps of a total hip arthroplasty to make sure that I am making the correct choices in terms of neck cut, depth of acetabular reaming, acetabular component positioning, and femoral stem, head, and neck selection.  As an example, here is a gallery of images saved on the C arm during a typical direct anterior minimally invasive total hip.

Hip Xrays

In the first two images we see the preoperative AP pelvis and hip xrays.  The first image taken intra-operatively is the 3rd image which shows the reamer being used to remove the remaining bone from the acetabulum.  I like to use the C-arm at this point to verify that the acetabulum has been reamed appropriately and I also get a good sense of how well the cup will sit in the acetabulum.  The next image shows the acetabulum being inserted.  The C-arm is used here to control the final position of the cup, setting the abduction and anteversion.  Next the size of the femoral trial is evaluated, and finally, once the the components are in place and the hip is relocated, the operative side is compared to the non-operative side.  This process makes SURE that there are no surprises when the postoperative xray is taken in the post-anesthetic care unit.


  1. Marcus


    I am doing a paper about Slipped Capital Femoral Epiphyses(SCFE’s) and I wanted to find the radiation dosage of intraoperative imaging.

    Unfortunately I have found no writings on that subject thus far.

    I would appreciate it if you could send me the average dosage of such imaging, or a website that would have the information listed.

    Thank you,
    Marcus Cimino

    1. admin

      Dear Marcus,
      I am not an expert on radiation dosing, so I would suggest that you start with the national library of medicine at http://www.pubmed.org.

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