Indications, cost and safety implications of traditional post-operative radiography following total hip replacement

Purpose: As routine check radiographs obtained in the recovery room following total hip arthroplasty present issues of concern regarding quality, cost and safety of both staff and patient, we wished to determine the usefulness and indications for this investigation as a screening tool for post-operative dislocation. MethodsA 10-year retrospective analysis of all total hip replacements performed in a single Regional Orthopaedic Hospital, considering the total number of hip arthroplasties performed and the number of acute recovery room dislocations using theatre records and patient notes. We then randomly selected the recovery room and departmental radiographs of 100 patients and compared them with regard to the need for repeat radiographs and subsequent costs generated. ResultsRecovery room radiographs were not statistically superior to clinical assessment in the diagnosis of acute post-operative dislocations (P=0.7), and these were associated with increased costs because it was necessary to repeat poor quality films (P=0.008). The use of recovery room radiography was also therefore associated with significant safety implications for patients and staff. ConclusionsThe conclusion was that recovery room radiographs are neither a safe, effective nor economical method of screening for dislocation. Furthermore, they fail to provide reliable or reproducible information and expose patients and staff to extra radiation. It is recommended therefore that recovery room radiographs should only be obtained for clinical indications, with most routine post-operative radiography being performed in a standardised fashion in the radiology department