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.

BACKGROUND/AIM 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. PATIENTS AND METHODS 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. RESULTS 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. CONCLUSION 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.