Pre-discharge postoperative radiographs after primary total knee replacement : tradition or science?

Area of Science:

• Orthopedic Surgery
• Radiology
• Health Economics

Background:

• Immediate postoperative radiographs are often considered unnecessary after total knee replacement (TKR).
• The routine use of pre-discharge radiographs following TKR lacks consistent evidence supporting its clinical utility.
• Potential benefits and drawbacks of eliminating routine inpatient X-rays after TKR require further investigation.

Purpose of the Study:

• To test the hypothesis that removing pre-discharge radiographs after total knee replacement (TKR) does not negatively affect patient outcomes.
• To evaluate the impact of eliminating routine inpatient X-rays on postoperative pain, rehabilitation, complications, and costs in TKR patients.

Main Methods:

• Retrospective analysis of prospectively collected data from 220 patients undergoing primary TKR.
• Patients were divided into two groups: one receiving routine pre-discharge radiographs (Surgeon A) and another group without (Surgeon B).
• Comparison of outcomes including pain, rehabilitation protocols, complications, medico-legal issues, and revision surgery rates.

Main Results:

• No significant differences were found in rehabilitation protocols, complications, medico-legal issues, or revision surgery rates between the groups.
• The group with pre-discharge radiographs reported greater knee pain (p = 0.01).
• Excluding pre-discharge films resulted in an approximate cost saving of $220 per patient and revealed inadequate quality in 58% of the films.

Conclusions:

• Eliminating routine inpatient pre-discharge radiographs after simple primary total knee replacement (TKR) is safe and does not compromise patient care.
• This practice change does not alter rehabilitation, identify standard complications, or have medico-legal implications.
• Removing these radiographs can reduce postoperative pain and healthcare costs associated with TKR.