Postoperative radiographs after total knee arthroplasty: a cost-containment strategy

We reviewed a single surgeon's experience with 646 consecutive total knee arthroplasties (TKAs) performed over a 6-year period to determine whether routine in-hospital radiographs could be safely avoided. Five hundred fourteen patients underwent 589 primary and 57 revision TKAs. One hundred thirty-two patients had bilateral procedures. Radiographs were obtained during the index hospitalization for 12 (2%) knees and were ordered selectively to assess femoral notching > or =3 mm, concomitant osteotomy, bulk allograft reconstruction, stem extension relative to existing hardware or screw holes, or falls during the index hospitalization. Radiographs were delayed until the initial postoperative office visit for the remaining 634 (98%) knees. Six hundred seventeen of 646 knees (96%) were evaluated at a mean follow-up of 4.3 years (range: 2 to 8 years). No patient experienced any complication that was considered to be attributable to not obtaining earlier postoperative radiographs. Three patients experienced late fractures and 7 patients developed perioperative soft-tissue complications or infections. None of these cases were adversely affected by delaying the initial postoperative radiographs. Eliminating in-hospital radiographs with radiologist interpretation resulted in a potential savings of $246 in hospital charges, $198 in private insurance reimbursements, and $65 in hospital costs per TKA. These findings indicate that radiographs following TKA can be delayed in most cases until the first postoperative office visit without compromising patient care.