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Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

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Economic Feasibility of Routine First Postoperative Radiographs in Minimally Invasive Bunion Surgery.

Taylor Schnepp¹, Chase Burzynski², Kyle A Lorenzo¹

¹Baptist Health Orthopedic Institute, Coral Gables, FL, USA.

Foot & Ankle Orthopaedics

|December 12, 2025

Summary

Routine postoperative radiographs after minimally invasive bunion surgery rarely change management. Eliminating these unnecessary imaging tests can significantly reduce healthcare costs for hallux valgus treatment.

Keywords:

MIS bunion foot and ankle orthopaedics foot and ankle surgery hallux valgus healthcare economics radiographic analysis

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Area of Science:

Orthopaedic Surgery
Health Economics

Background:

Orthopaedic procedures incur significant costs beyond the surgery itself, including follow-up care and imaging.
Evidence suggests routine postoperative radiographs lack clinical benefit, questioning their cost-effectiveness.
This study assesses the economic value of first postoperative radiographs following minimally invasive surgery for hallux valgus.

Purpose of the Study:

To evaluate the economic feasibility of first postoperative radiographs (FPOV) after fourth-generation minimally invasive surgery (MIS) transverse double osteotomy for hallux valgus.
To determine the impact of FPOV radiographs on patient management and associated costs.

Main Methods:

Retrospective analysis of 245 patients undergoing MIS transverse double osteotomy for hallux valgus (Jan 2019 - Dec 2021).
Assessed changes in management based on FPOV radiographs (average 1.38 weeks post-op).
Estimated FPOV radiograph costs using Medicare, private insurance, and self-pay data; extrapolated national costs.

Main Results:

Only 1.6% of patients had FPOV radiographic findings that altered management.
Identified reasons for management change included loss of reduction, fracture, and subluxation.
Estimated annual national costs for routine MIS bunion radiographs range from $3.5 million to $23.3 million.

Conclusions:

Routine FPOV radiographs after MIS hallux valgus surgery seldom lead to changes in patient management.
Radiographs are rarely justified in the absence of clinical signs or symptoms.
Recommends physical evaluation at FPOV, suggesting significant healthcare savings by omitting routine radiographs.