Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues
Background: Intraoperative vascular injury during total hip arthroplasty represents a catastrophic complication. Acetabular screw placement represents one possible mode of injury. The purpose of this study was to evaluate the utility of various fluoroscopic views in the detection of intrapelvic scre...
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2021-04-01
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doaj-75ddd0affbab407f8b5f72815024804a2021-05-16T04:24:00ZengElsevierArthroplasty Today2352-34412021-04-018226230Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma ColleaguesJacob M. Wilson, MD0Jeremiah A. Pflederer, MD1Andrew M. Schwartz, MD2Kevin X. Farley, BA3Nickolas B. Reimer, MD4Corresponding author. Jacob M Wilson, 59 S Executive Park NW, Atlanta, GA 30329. Tel.: +1 404-778-7777.; Department of Orthopaedic Surgery, Atlanta, GADepartment of Orthopaedic Surgery, Atlanta, GADepartment of Orthopaedic Surgery, Atlanta, GADepartment of Orthopaedic Surgery, Atlanta, GADepartment of Orthopaedic Surgery, Atlanta, GABackground: Intraoperative vascular injury during total hip arthroplasty represents a catastrophic complication. Acetabular screw placement represents one possible mode of injury. The purpose of this study was to evaluate the utility of various fluoroscopic views in the detection of intrapelvic screw penetration. Methods: A radiopaque pelvis Sawbones model was instrumented with a hemispherical acetabular component. Four intrapelvic quadrants were defined. Screws were placed, 3 in each quadrant, and imaged sequentially at 3 depths: 0 mm, 5 mm, and 10 mm penetrated. Eight fluoroscopic images were used: anteroposterior, inlet, outlet, iliac oblique, obturator oblique, “down the wing,” obturator outlet, and a “quad” view. Three blinded, independent surgeons evaluated the images for intrapelvic screw penetration. Images were analyzed in isolation and as a “triple-shot series” consisting of the “quad,” obturator outlet, and iliac oblique views. Sensitivity and specificity values were then calculated. Results: In isolation, the “quad” view had the highest sensitivity for screw penetration (62%). The triple-shot series was found to be 100% sensitive in all 4 quadrants for detecting 10 mm of screw penetration. The specificity of the series was found to be 100% in all quadrants except for the posterior superior quadrant where it was 67%. Interobserver agreement approached perfection (Kappa ≥0.947) between all surgeons (P < .001) when using the 3-view series. Conclusions: This study is the first to assess the use of fluoroscopy in the detection of intrapelvic penetration of transacetabular screws. We found that a 3-radiograph series provided a sensitive and specific metric for the detection of intrapelvic screw penetration.http://www.sciencedirect.com/science/article/pii/S2352344121000297AcetabularTotal hipFluoroscopyScrewRadiologyArthroplasty |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jacob M. Wilson, MD Jeremiah A. Pflederer, MD Andrew M. Schwartz, MD Kevin X. Farley, BA Nickolas B. Reimer, MD |
spellingShingle |
Jacob M. Wilson, MD Jeremiah A. Pflederer, MD Andrew M. Schwartz, MD Kevin X. Farley, BA Nickolas B. Reimer, MD Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues Arthroplasty Today Acetabular Total hip Fluoroscopy Screw Radiology Arthroplasty |
author_facet |
Jacob M. Wilson, MD Jeremiah A. Pflederer, MD Andrew M. Schwartz, MD Kevin X. Farley, BA Nickolas B. Reimer, MD |
author_sort |
Jacob M. Wilson, MD |
title |
Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues |
title_short |
Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues |
title_full |
Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues |
title_fullStr |
Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues |
title_full_unstemmed |
Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues |
title_sort |
intraoperative radiographic detection of intrapelvic acetabular screw penetration: lessons learned from our trauma colleagues |
publisher |
Elsevier |
series |
Arthroplasty Today |
issn |
2352-3441 |
publishDate |
2021-04-01 |
description |
Background: Intraoperative vascular injury during total hip arthroplasty represents a catastrophic complication. Acetabular screw placement represents one possible mode of injury. The purpose of this study was to evaluate the utility of various fluoroscopic views in the detection of intrapelvic screw penetration. Methods: A radiopaque pelvis Sawbones model was instrumented with a hemispherical acetabular component. Four intrapelvic quadrants were defined. Screws were placed, 3 in each quadrant, and imaged sequentially at 3 depths: 0 mm, 5 mm, and 10 mm penetrated. Eight fluoroscopic images were used: anteroposterior, inlet, outlet, iliac oblique, obturator oblique, “down the wing,” obturator outlet, and a “quad” view. Three blinded, independent surgeons evaluated the images for intrapelvic screw penetration. Images were analyzed in isolation and as a “triple-shot series” consisting of the “quad,” obturator outlet, and iliac oblique views. Sensitivity and specificity values were then calculated. Results: In isolation, the “quad” view had the highest sensitivity for screw penetration (62%). The triple-shot series was found to be 100% sensitive in all 4 quadrants for detecting 10 mm of screw penetration. The specificity of the series was found to be 100% in all quadrants except for the posterior superior quadrant where it was 67%. Interobserver agreement approached perfection (Kappa ≥0.947) between all surgeons (P < .001) when using the 3-view series. Conclusions: This study is the first to assess the use of fluoroscopy in the detection of intrapelvic penetration of transacetabular screws. We found that a 3-radiograph series provided a sensitive and specific metric for the detection of intrapelvic screw penetration. |
topic |
Acetabular Total hip Fluoroscopy Screw Radiology Arthroplasty |
url |
http://www.sciencedirect.com/science/article/pii/S2352344121000297 |
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