Utility of Radiographs for Asymptomatic Patients Following Primary Anatomic and Reverse Total Shoulder Arthroplasty

Background: Radiographs are frequently obtained after total shoulder arthroplasty (TSA) to confirm implant placement and follow the status of the bone and prostheses; however, standardization of their use is lacking. There are concerns regarding frequent use of radiographs due to their cost and patient radiation exposure. The aim of this study is to assess the postoperative radiograph frequency and efficacy in primary anatomic and reverse total shoulder arthroplasty. We hypothesize that multiple radiographs taken beyond the initial 2-week postoperative interval are of uncertain benefit for both primary anatomic and reverse total shoulder arthroplasties, regardless of the presence of symptoms.

Methods: A retrospective chart and imaging review was conducted on all patients who underwent primary TSA between 2014 and 2021, with documentation of at least 2 years of follow-up. All available postoperative radiographs, radiologist interpretations, and clinic notes were followed up for 2 years after the date of surgery, or until another surgery was performed within the 2-year timeframe. Radiographs were assessed for component positioning, fractures, loosening, and dislocation. Clinic notes were also checked for changes in patient management. Patients were grouped by surgery type (anatomic/reverse).

Results: A total of 213 patients (234 surgeries) were identified (55 anatomic TSA, 179 reverse TSA). The mean number of radiographs within the first 2 years of surgery was 3.6 for anatomic TSA and 4.0 for reverse TSA. 166 patients were asymptomatic and had only 3 positive X-rays and zero revision rate in the first 2 years. No changes in management were implemented based on these routine radiographs. 68 surgeries were symptomatic, of which 21 had positive X-rays. Of this subgroup, 19 (90.5%) underwent revision.

Conclusion: Routine radiographs are overused and typically do not lead to any changes in asymptomatic patients in the first 2 years after TSA. For patients experiencing pain or limited range of motion, ongoing assessment using additional X-rays, CT scans, or other diagnostic tests is recommended for effective monitoring.