Retrospective Review of Arthroplasty Radiographs: How to Define an Adequate Radiograph

Introduction Adequacy of postoperative hip and knee radiographs has a direct impact on its interpretation. We undertook a quality improvement project by creating local standards to meet the arthroplasty team expectations for a satisfactory radiograph. The purposes of the study are 1. Assessment of the adequacy of radiographs according to defined criteria, and 2. Correlation of system and patient factors with inadequate radiographs. Methods Stage I: We conducted a single centre, retrospective audit to check the adequacy of a postoperative radiography following a total hip or knee replacement. A total of 100 radiographs were assessed against the nine criteria laid out with the consensus of orthopaedic surgeons and radiologists. Stage II: We created a quality improvement proforma for use in the radiology department. We re-assessed 100 radiographs during the second cycle against the nine criteria to check the adequacy of hip and knee arthroplasty radiographs, Results Stage I: Of 100 radiographs, 51 were from the knee and 49 from the hip arthroplasty group. Sixty-nine radiographs were adequate considering overall criteria, and 31 radiographs were inadequate. The inadequacy in radiographs was related to the visibility of prosthesis, cement or relevant anatomy. Stage II: We created a quality improvement performa for use in radiology department, highlighting the nine initial criteria. One hundred radiographs of hip and knee arthroplasty were re-assessed. Overall, 84 radiographs fulfilled the criteria of being adequate. Conclusion Adequacy of knee and hip arthroplasty radiographs is essential in picking up pathologies that can be missed otherwise. We present simple criteria to improve the adequacy of x-ray and prevent repetition of radiographs.