Do more postoperative X-rays improve patient perception following total knee arthroplasty? A prospective randomized
A Coelho1, N Carbó2, C Yela-Verdú2
1Department of Orthopedic Surgery and Traumatology, Parc Taulí Hospital Universitari, Institut d'Investigació I Innovació Parc Tauli (I3PT-CERCA), Universitat Autònoma de Barcelona, Parc Taulí, 1, 08208, Sabadell, Barcelona, Spain. alexandrecoelholeal@gmail.com.
Journal of Orthopaedic Surgery and Research
|February 27, 2026
Summary
Fewer postoperative X-rays after total knee arthroplasty (TKA) are as effective as more frequent imaging. A reduced X-ray protocol (two views) demonstrated similar or improved patient outcomes and satisfaction compared to five views, without impacting complication detection.
Area of Science:
- Orthopedic Surgery
- Radiology
- Patient-Reported Outcomes
Background:
- Postoperative management following total knee arthroplasty (TKA) often includes serial radiographic imaging.
- The optimal frequency of postoperative X-rays to assess recovery and patient perception remains debated.
- Evaluating the impact of varying radiographic protocols on patient outcomes is crucial for optimizing care pathways.
Purpose of the Study:
- To compare the effects of two versus five postoperative X-ray protocols on patient perception after TKA.
- To assess functional outcomes, quality of life, patient satisfaction, and complication detection between different X-ray frequencies.
- To determine if a reduced radiographic follow-up impacts patient confidence and clinical results.
Main Methods:
- A prospective randomized study involving 206 TKA patients.
- Patients were assigned to either a five-X-ray protocol (Group 1) or a two-X-ray protocol (Group 2).
- Functional outcomes (Knee Society Score - KSS, Short Form-12 - SF-12), satisfaction, and complications were monitored over a 1-year follow-up.
Main Results:
- No significant differences in functional outcomes (KSS-Function, SF-12 physical) or patient satisfaction were observed between the two groups.
- Patients in the two-X-ray group showed slightly higher KSS-Knee scores and SF-12 mental scores.
- Complication rates were similar between groups, with no added benefit in complication detection from the five-X-ray protocol.
Conclusions:
- A reduced postoperative X-ray protocol (two views) following TKA is non-inferior to a more extensive protocol (five views) regarding patient outcomes and satisfaction.
- Limited radiographic follow-up may be sufficient, potentially reducing costs and radiation exposure without compromising patient perception or clinical results.
- These findings support a more conservative approach to postoperative radiographic surveillance in TKA patients.
