Immediate Postoperative Portable Radiograph After Total Knee Replacements: A Necessity or a Burden?

Abstract

Background:Total Knee Replacement (TKR) is one of the most commonly performed orthopaedic surgery(1). Immediate postoperative portable radiographs are performed after primary TKR in order to identify any potential complications and technical flaws. It also serves as a reference for comparison with subsequent radiographs. The aim of this study was to evaluate the clinical and economical value of these radiographs in TKR. It compares the quality of the portable radiograph, taken immediately post-operation, with in-suite radiographs taken 5-7 weeks post-operationMethods:In this retrospective study, a consecutive series of 389 TKR patients from January-2011 to March-2015 were reviewed. Radiological evaluation consisted of assessing the beam angle and the exposure on the images. Implant positioning was also compared by measuring the anatomical axis to look for component alignment discrepancies.Results:The quality of the portable recovery room radiograph was overall inferior to the radiology suite radiograph regarding both beam angle and exposure. Component alignment discrepancies were also identified in the angle measurements between both types of radiographs.Conclusion:Therefore, our study demonstrated that there is no clinical or financial value obtained from postoperative portable radiograph. Furthermore, Immediate recovery room radiographs should be avoided from being performed routinely and may only be used in cases where the surgeon is utilizing a new implant or technique. No external funding was provided for this study from any source.

Is Immediate Postoperative Radiograph Necessary Following Robotic-Assisted Total Knee Arthroplasty?

“…Several previous studies have argued that postoperative radiographs following TKA are unnecessary [6][7][8][15][16][17][18] . Moskal et al reviewed 646 TKAs over a 6-year period, of which, immediate postoperative radiographs were taken for only 12 TKAs and for the remaining 634 radiographs were delayed until follow-up 15 .…”

“…This can lead to multiple imaging attempts to obtain the proper views, leading to increased radiation exposure and time in the operating room. In a study by Aljawder et al, they compared the quality of postoperative portable recovery room Xrays with radiology suite X-rays in patients who underwent TKA 6 . After reviewing X-rays of 382 patients, they concluded that 40% of the recovery room radiographs were inadequate for analysis compared to those obtained in the radiology suite, which were all deemed to be adequate 6 .…”

“…In a study by Aljawder et al, they compared the quality of postoperative portable recovery room Xrays with radiology suite X-rays in patients who underwent TKA 6 . After reviewing X-rays of 382 patients, they concluded that 40% of the recovery room radiographs were inadequate for analysis compared to those obtained in the radiology suite, which were all deemed to be adequate 6 . This agrees with our study results, as the templated posterior slope more closely correlated to the 2 week postoperative X-ray (completed in the office) as compared to the POD0 X-ray (done in the hospital).…”

“…Accepted Manuscript radiographs 6 . These postoperative radiographs require extra time in the operating room, add cost to the operation, and expose patients to radiation.…”

Routine Post-operative Radiographs Following Hip Hemiarthroplasty: Is It a Necessity?

“…There is sufficient evidence in the literature to suggest that routine postoperative radiographs in orthopaedic patients seldom affect the clinical outcome or management of the patients [ 13 - 15 ]. Although most of these studies have evaluated patients who underwent surgeries like total knee arthroplasty, total hip arthroplasty or spinal surgeries, we found similar results in patients being managed with hip hemiarthroplasty.…”