Clinical Value of Routine Follow-Up Radiographs in Total Joint Arthroplasty

Background: Performing routine radiographs after total joint arthroplasty (TJA) in post-operative follow-up, typically at four weeks and 12 months, in addition to baseline radiographs obtained immediately post-operatively, is common practice in many institutions. Despite research indicating it may not alter management, it is associated with substantial financial, resource, and time costs. This study aimed to assess the impact of routine radiographs on the management of TJA patients in a UK district general hospital.

Method: This retrospective observational study included patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) between September 2019 and December 2020. Patient data, including demographics, surgery details, and follow-up outcomes, were extracted from electronic medical records. Follow-up visits were categorized as four-week and 12-month post-surgery intervals, allowing for variability in timing due to COVID-19-related disruptions. Radiographic assessments, including requests, reports, and findings from clinic letters, were reviewed to determine any radiological abnormalities or changes in management. Descriptive statistics were applied to evaluate the frequency and context of routine versus unplanned radiographs, providing insights into post-operative care patterns.

Results: A total of 173 TJA patients met the inclusion criteria, with 54 exclusions due to lack of follow-up. A total of 56 patients (32%) had routine radiographs within the one-year follow-up period. No radiological abnormalities were detected on these, and none of the patients returned to the theatre. Of the 24 patients who presented with acute clinical concerns and had unplanned radiographs, eight (33%) required a return to theatre.

Conclusion: Routine follow-up radiographs in our study did not reveal any significant abnormalities nor did they result in changes to patient management, indicating a lack of clinical utility. Given that these radiographs impose considerable financial and resource burdens, their necessity is questionable. Based on the National Health Service (NHS) tariff costs, the potential savings from discontinuing routine radiographs in our cohort amounted to £3,129 annually. Extrapolating this to the national level, with approximately 150,000 total knee and hip replacements performed each year in the UK, suggests that substantial costs could be avoided.