The Frequency, Reasoning, and Impact of Repeated Radiographs at the Initial Orthopedic Arthroplasty Visit

Patients presenting to an orthopedic clinic with joint pain often seek prior care and imaging before consultation. It is unknown how often orthopedic surgeons must repeat imaging and whether repeat imaging has an impact on diagnosis or management. The purpose of this study was to determine the frequency, reason, and impact of repeating radiographs in outpatient orthopedic clinics.

Patients ≥18 years of age presenting with hip and/or knee pain were prospectively enrolled at five arthroplasty clinics from January 2019 until June 2020. Before the initial visit, surveys were distributed to patients regarding the reason for their visit, prior care, and prior diagnostic imaging. At the conclusion of the visit, surgeons reported if repeat radiographs were obtained, and if so, surgeons documented the views ordered, the reasoning for new films, and if diagnosis or management changed as a result. Patients were grouped based on repeat imaging status, and of those with repeat imaging, subgroup analysis compared patients based on if management changed.

Of 292 patients, 256 (88%) had radiographs before their office visit, and 167 (65%) obtained repeat radiographs. Radiographs were most commonly repeated if they were inaccessible (47%), followed by if they were non-weight-bearing (40%). Repeated radiographs changed the diagnosis in 40% of patients and changed management in 22% of patients.

Most patients underwent repeat radiography at their orthopedic visit. The primary reasons were owing to accessibility or the patient being non-weight-bearing. Repeat radiographs changed management in almost one-quarter of patients.