Intraoperative Radiation Exposure with Percutaneous vs Hybrid Hallux Valgus Correction: A Comparative Study.

Background: Minimally invasive surgery (MIS) for hallux valgus (HV) deformity have gained popularity over traditional open techniques in recent years. However, MIS techniques pose concerns about increased fluoroscopy use and potential radiation exposure. This study seeks to compare the radiation exposure between percutaneous HV correction and a hybrid technique using a mini C-arm.

Methods: In this prospective study, 68 patients underwent HV correction surgery between February 2022 and July 2023. Group 1 consisted of 37 patients who underwent percutaneous chevron and Akin osteotomy whereas group 2 consisted of 31 patients who underwent mini-open metatarsal distal chevron osteotomy + Akin percutaneous osteotomy (hybrid) technique. The patients were nonrandomized and allocated to each group according to their surgeons' preference. Radiation exposure was measured using dose-area product (DAP), exposure duration, and passive dosimeters for the surgeon's extremity, lens, and chest, as well as active dosimeters for the surgical team and patients.

Results: Group 1 exhibited higher mean DAP (3.02 ± 1.91 cGy/cm²) compared with group 2 (1.56 ± 1.57 cGy/cm², P = .001). Mean radiation exposure duration was also higher in group 1 (56.74 ± 18.40 seconds) than in group 2 (23.54 ± 18.70 seconds, P < .001). Despite higher radiation exposure per case, cumulative doses remained below occupational safety thresholds set by the International Commission on Radiological Protection (ICRP) which are 5 cGy for whole body and lens of the eye, and 50 cGy for hand exposure.

Conclusion: Although percutaneous HV correction is associated with greater intraoperative fluoroscopy use, cumulative radiation exposure to patients and surgical teams remains well within ICRP-recommended safety limits when mini C-arm fluoroscopy is used. These findings support the continued use of percutaneous techniques in appropriately selected patients and settings.