Immediate Postoperative Radiographs After Shoulder Arthroplasty Are Often Poor Quality and Do Not Alter Care

Abstract

Background It is technically difficult to obtain highquality, postoperative shoulder radiographs immediately after surgery. Further, poor-quality radiographs may be unlikely to change clinical practice or improve patient outcomes. We therefore questioned the value of routine postoperative radiographs after shoulder arthroplasty. Questions/Purposes We asked whether (1) postanesthesia care unit (PACU) radiographs can reasonably serve as a baseline for future studies; and (2) routine PACU radiographs change clinical care. (3) We also determined the charges associated with routine PACU radiographs and formal radiographic interpretation of these images. Methods We retrospectively compared the radiographs of 283 patients who had shoulder arthroplasties (Group 1) who underwent PACU radiographs with those of 241 patients (Group 2) who had their first postoperative radiographs at a later date. Radiographs were compared for quality, ability to serve as a baseline, and their influence on clinical course. Orthopaedic evaluation of each radiograph and the radiographic report were compared and charges were analyzed.

Quality and Utility of Immediate Formal Postoperative Radiographs in Ankle Fractures

“…Similar results were found when postoperative radiographs were reviewed following scarf osteotomy for hallux valgus, 19 supracondylar humerus fractures, 13 spinal fusions, 18 and shoulder arthroplasty. 21 In the series of 30 ankle fractures by Harish et al, 10 formal postoperative images were comparable to hard-copy intraoperative images and did not prompt any management changes.…”

ACR Appropriateness Criteria® Imaging After Shoulder Arthroplasty: 2021 Update

“…These may include anterior-posterior, anterior-posterior Grashey, scapular Y, and axillary views [10,13]. Intraoperative and immediate postoperative radiographs are also ordered by some surgeons, but their benefit, without a specific indication, has been questioned because of limitations inherent to the portable nature of the examination, patients' difficulties in cooperating with the various views, and low impact on overall patient care [14]. The frequency of follow-up radiographs varies depending on the surgeon's preference but usually accompanies their follow-up visits anywhere between 3 months and 1 year postsurgery.…”

Are immediate postoperative X-Rays valuable in evaluating complications of primary total hip arthroplasty?

“…Immediate postoperative X-rays are often used to screen for unrecognized intraoperative complications, assess implant placement, and establish a radiographic baseline for follow-up. However, the value of PACU X-rays has been challenged, given the low incidence of serious complications and the limited quality in knee, hip, and shoulder arthroplasties [8][9][10][14][15][16][17][18]. Furthermore, the cost-effectiveness is particularly questioned, although radiographic costs vary widely across the countries [9,19].…”