John Charnley Award: A Quantitative Fluoroscopic Tool Improves Acetabular Fragment Positioning in Periacetabular Osteotomy

Background: Radiographic assessment of acetabular fragment positioning during periacetabular osteotomy (PAO) has been linked to hip survivorship. Intraoperative plain radiographs are time and resource intensive, while fluoroscopy can introduce image distortion affecting measurement accuracy. Our purpose was to determine whether intraoperative fluoroscopy-based measurements with a distortion correcting fluoroscopic tool improved PAO measurement targets. Methods: We retrospectively reviewed 570 PAOs; 136 PAOs utilized a distortion correcting fluoroscopic tool, and 434 PAOs performed with routine fluoroscopy, prior to this technology. Lateral center-edge angle (LCEA), acetabular index (AI), posterior wall sign (PWS), and anterior center-edge angle (ACEA) were measured on preoperative standing radiographs, intraoperative fluoroscopic images, and postoperative standing radiographs. Defined target zones of correction were AI: 0-10 degrees, ACEA: 25-40 degrees, LCEA: 25-40 degrees, PWS: negative. Postoperative correction in zones and patient-reported outcomes were compared using chi-square tests and paired t-tests, respectively. Results: The average difference between postcorrection fluoroscopic measurements and 6-week postoperative radiographs was 0.21 degrees for LCEA, 0.01 degrees for ACEA, and -0.07 degrees for AI (all P <.01). The PWS agreement was 92%. The percentages of hips meeting target goals overall improved with the new fluoroscopic tool: 74%-92% for LCEA (P <.01), 72%-85% for ACEA (P <.01), and 69 versus 74% for AI (P =.25), though there was no improvement in PWS (85 versus 85%, P =.92). All patient-reported outcomes except PROMIS Mental Health were significantly improved at most recent follow-up. Conclusions: Our study demonstrated improved PAO measurements and target goals with the use of a distortion correcting quantitative fluoroscopic real-time measuring device. This value-additive tool gives reliable quantitative measurements of correction without interfering with surgical workflow. (c) 2023 Elsevier Inc. All rights reserved.