Is There a Need for Recovery Room Radiographs Following Uncomplicated Primary Total Knee Arthroplasty?

Abstract

Introduction Total knee arthroplasty (TKA) is one of the most common orthopedic procedures performed in the United States. Obtaining radiographs in the post-anesthesia care unit (PACU) has been the standard of care at most hospitals. The purpose of this study was to examine the utility and cost-effectiveness of immediate, postoperative radiographs in regards to operative decision-making to prevent complications within 90 days after primary TKA. Methods A retrospective review of 4,830 consecutive patients who underwent cemented or uncemented TKA between January 2016 and June 2019 at a large, regional medical center was performed. International Classification of Diseases, Tenth Revision (ICD-10) codes were used to track any readmissions within 90 days of TKA. If readmission was for a mechanical complication, including fracture, dislocation, or component loosening, PACU radiographs were reviewed for any abnormalities that may have prevented readmission. Results There were 195 readmissions (195 patients), of which 17 were due to mechanical complications. There was no evidence of fracture or abnormality appreciated on any of the reviewed PACU radiographs by either the reading radiologist or the senior authors. Assuming all fractures were noted on immediate, postoperative radiographs, the cost associated with identifying a single fracture in 2,415 patients was $1,072,260. Conclusion Routine radiographs in the recovery room after an uncomplicated primary TKA are not a reliable mechanism for preventing mechanical complications and do not alter patient care.

Keywords: knee arthroplasty; radiology.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2021, Novack et al.

Figures

Figure 1. Readmission radiographs post primary total knee arthroplasty showing a periprosthetic distal femur fracture (left); status post revision total knee arthroplasty due to periprosthetic distal femur fracture (right)

Figure 2. Readmission radiographs post primary total knee arthroplasty demonstrating a periprosthetic patella fracture (left); status post surgical fixation of periprosthetic patella fracture (right)

Figure 3. Readmission radiographs post primary total knee arthroplasty showing instability of the knee (left); revision total knee arthroplasty due to instability (right)

Figure 4. Readmission radiographs post primary total knee arthroplasty demonstrating instability of the tibial component (left); revision total knee arthroplasty for aseptic loosening (right)