Optimising Post-Operative Imaging in Hemiarthroplasty

Hip hemiarthroplasty is a common procedure for femoral neck fractures in the geriatric population. Immediate implant-related complications such as dislocation, periprosthetic fracture, and leg length discrepancy are uncommon, but should be ruled out with the use of post-operative X-rays. There is some debate as to the timing of the post-operative X-rays. Some orthopaedic units prefer immediate postoperative in theatre X-rays, while other units opt for departmental X-ray the following day. The aim of this study was to compare in theatre postoperative X-rays versus departmental next day X-rays, to see if there was any significant difference in diagnosing immediate implant related complications.

This is a single centre retrospective observational study including radiologic review of AP Pelvis X-rays for patients who had a cemented or uncemented bipolar hemiarthroplasty for neck of femur fracture from May 2018 until January 2023. Two independent orthopaedic surgeons reviewed the X-rays, to exclude any periprosthetic fractures, dislocations or other immediate implant related complications. A total of 1115 patients who underwent uncemented or cemented bipolar hemiarthroplasty data was collected from 2018 to 2023.Patients were operated using Anterolateral or Posterior approach as per preference of the operating consultant.

Minimal or no complications were observed in 1,095 (98.2%) patients, both immediately after hip hemiarthroplasty and 24 hours postoperatively. At the same time, 20 (1.8 %) patients had complications, which were picked up on the x-rays two weeks or later after the procedure. It explains that postoperative in-theatre X-rays have negligible clinical influence. It emphasises the lack of early postoperative problems detected by intraoperative theatre x-rays after hip hemiarthroplasty. This gives an indication that such early postoperative imaging might not be critical in recognising early complications.

Day one post operative, inter departmental, post mobilization hip x-rays are reliable, cost effective, less time consuming, require less manual handling, better quality and are sufficient enough to out rule implant related complications, in patients post Bipolar Hip Hemiarthroplasty.