Does the use of intraoperative CT scan improve outcomes in Orthopaedic surgery?
Abstract
A meta-analysis comparing intraoperative 3D imaging (iCT) against conventional fluoroscopy across spine, pelvis, and trauma surgeries. Data confirms iCT significantly reduces implant malposition and revision rates without incurring statistically significant operative delays.
Precision Navigation vs. Standard Fluoroscopy
Key Finding
"Intraoperative CT reduced the odds of implant malposition by 65% (OR 0.35, p = 0.0002) and revision rates by 82% (OR 0.18, p = 0.03)."
Background: Conventional 2D fluoroscopy fails to adequately visualize complex anatomical regions like the pelvis, spine, and syndesmosis, often requiring postoperative CT verification and subsequent revision surgeries. While intraoperative 3D imaging (iCT) offers multiplanar reconstruction, its comparative efficacy regarding surgical time and clinical revision rates required rigorous validation.
Methods: This systematic review analyzed 31 studies comprising 658 patients. The authors compared intraoperative 3D imaging (including 3D C-arms and mobile CTs like O-Arm/Airo) against conventional 2D fluoroscopy. The primary endpoints were accuracy of implant placement, revision rates, and surgical duration. Statistical analysis utilized a random-effects model with heterogeneity assessed via the I² statistic.
Results: Meta-analysis confirms iCT is superior to fluoroscopy for implant accuracy (Odds Ratio 0.35 [95% CI 0.20, 0.62], p = 0.0002). Furthermore, access to iCT significantly decreased the necessity for revision surgeries due to faulty placement (OR 0.18 [0.04, 0.83], p = 0.03). While mean surgical time increased by 4.19 minutes with iCT, this difference was not statistically significant (p = 0.57). In 13.5% of cases, intraoperative scan findings triggered an immediate alteration of the surgical plan.
Conclusion: Implementation of intraoperative 3D imaging provides a definitive safety advantage, ensuring precise implant execution and eliminating the need for secondary revision procedures. The negligible impact on operative duration validates iCT as a high-value asset for complex spine, pelvic, and articular trauma reconstruction.