Achieving a Spherical Femoroplasty During Hip Arthroscopy with Computer Assisted Visualization Software: A Prospective Single-Blinded Randomized Controlled Multi-Surgeon Study

Background: Surgical correction of the cam deformity in patients with Femoroacetabular Impingement (FAI) through femoroplasty is one of the most technically demanding aspects of hip arthroscopy with inaccuracies directly impacting patient outcomes. This study aims to evaluate intraoperative femoroplasty time and radiation exposure in patients undergoing cam resection randomized to the use of image-based Computer-Assisted Visualization (CAV) software versus conventional fluoroscopy. Methods and Findings: Patients undergoing hip arthroscopy for cam dependent FAI in a high-volume hip preservation practice with two experienced hip preservation surgeons (one senior, one junior) were prospectively enrolled in the study. Randomization into the conventional fluoroscopy (control) or CAV arms was performed at the time of surgery. Surgical data, as well as preoperative and postoperative radiographic indices were evaluated. There were 18 patients in the control group and 19 patients in the CAV group. There were no significant differences when comparing the control and CAV groups on the basis of femoroplasty time (17.8 ± 10.2 vs. 23.4 ± 15.8 minutes; p=0.26) or fluoroscopic exposure time (39.8 ± 36.4 vs. 56.8 ± 79.8 seconds; p=0.45). The senior surgeon had significantly lower femoroplasty time (14.1 ± 7.3 vs. 31.0 ± 7.6 minutes; p=0.002) and radiation exposure in the conventional fluoroscopy group compared to the junior surgeon (4.9 ± 3.6 vs. 12.9 ± 6.4 mGy; p=0.03). However, there were no significant differences in femoroplasty time (20.1 ± 16.2 vs. 29.4 ± 10.1 p=0.27) or radiation exposure between the two surgeons in the CAV cohort (5.7 ± 2.7 vs. 8.9 ± 5.2; p=0.13). The junior surgeon also had lower fluoroscopic exposure time (91.0s vs. 44.1s; p=0.11) in patients receiving CAV femoroplasty. Conclusion: The CAV software does not significantly lengthen femoroplasty or fluoroscopy time during cam resection. Additionally, CAV software may decrease radiation exposure without increasing operative time during the learning curve in hip arthroscopy, supporting this technology as promising tool for performing accurate and reliable cam resection during hip arthroscopy.