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Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion

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Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty.

Alex M Moses¹, Christian Guier¹, Thomas W Wright²

¹Department of Orthopedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.

Journal of Shoulder and Elbow Surgery

|December 2, 2022

Summary

Routine immediate postoperative radiographs rarely detect complications after shoulder arthroplasty (SA), with only 0.2% identified. These findings did not alter patient management, suggesting routine imaging may be unnecessary.

Keywords:

X-ray XR anatomic cost reoperation reverse revision

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Area of Science:

Orthopedic Surgery
Radiology
Arthroplasty

Background:

Intraoperative complications following shoulder arthroplasty (SA) are infrequent.
The utility of immediate postoperative radiographs in SA, particularly revision cases, remains under-evaluated.
Existing literature questions the routine use of immediate postoperative radiographs.

Purpose of the Study:

To assess the diagnostic yield of immediate postoperative radiographs in identifying complications after primary or revision shoulder arthroplasty.
To determine if identified complications led to changes in immediate postoperative management.
To evaluate the role of these radiographs in revision SA.

Main Methods:

Retrospective review of 4063 shoulder arthroplasties (primary and revision) from a multi-institutional database.
Analysis of immediate postoperative radiographs read by musculoskeletal radiologists and the surgical team.
Review of medical records to correlate radiographic findings with changes in patient management.

Main Results:

Radiographs identified complications in only 0.2% (10 of 4063) of cases.
No identified complication altered immediate postoperative management.
Revision arthroplasty had a higher complication detection rate (1%) than primary arthroplasty (0.1%). Revision anatomic total shoulder arthroplasty (aTSA) showed a higher rate (3.1%) than revision reverse shoulder arthroplasty (RSA) (0.4%).

Conclusions:

Routine immediate postoperative radiographs have a low yield in detecting complications after shoulder arthroplasty.
Postoperative management was consistently unaltered until the first clinical visit.
The findings suggest reconsidering the routine practice of obtaining immediate postoperative radiographs due to limited clinical impact and potential medicolegal implications.