Incidental findings detected on preoperative CT imaging obtained for robotic-assisted joint replacements: clinical importance and the effect on the scheduled arthroplasty

Abstract

Objective To determine the type and frequency of incidental findings detected on preoperative computed tomography (CT) imaging obtained for robotic-assisted joint replacements and their effect on the planned arthroplasty. Materials and methods All preoperative CT examinations performed for a robotic-assisted knee or total hip arthroplasty were obtained. This resulted in 1432 examinations performed between September 2016 and February 2020 at our institution. These examinations were initially interpreted by 1 of 9 fellowship-trained musculoskeletal radiologists. Using a diagnosis search, the examination reports were then reviewed to catalog all incidental findings and further classify as significant or non-significant findings. Demographic information was obtained. In those with significant findings, a chart review was performed to record the relevant workup, outcomes, and if the planned arthroplasty was affected. Results Incidental findings were diagnosed in 740 (51.7%) patients. Of those with incidental findings, 41 (5.5%) were considered significant. A significant finding was more likely to be detected in males (P = 0.007) and on the hip protocol CT (P = 0.014). In 8 patients, these diagnoses resulted in either delay or cancelation of the arthroplasty. A planned total hip arthroplasty was more likely to be altered as compared to a knee arthroplasty (P = 0.018). Conclusion Incidental findings are commonly detected by radiologists on preoperative CT imaging obtained for robotic-assisted joint replacement. Several were valuable findings and resulted in a delay or even cancelation of the planned arthroplasty after the detection of critical diagnoses, which if not identified may have resulted in devastating outcomes.

Incidental Findings in Low-Dose Full-Body Imaging Taken for Total Hip and Knee Arthroplasty

“…Similar to our study, the case was delayed due to scheduling of additional imaging and interpretation of the findings, which was ultimately determined to be a benign angioleiomyoma. However, Tran et al 6 found much higher rates of cancellations and delayed TJAs. Three cases (7.3%) resulted in surgery cancellation due to the diagnoses of incidental malignancies; two of which required oncologic surgery.…”

“…7 Similarly, Tran et al reported incidentalomas through preoperative CT imaging in 740 (51.7%) of 1,432 CA TJA cases; 41 (5.5%) of those findings were considered to be significant. 6 However, when using imaging modalities such as CT and plain radiographs, patients are typically subjected to multiple radiographs, leading to increased radiation exposure. 8,9 The EOS system (EOS Imaging, Paris, France) is an alternative to standard imaging techniques as it can provide quality images while reducing radiation dose.…”

“…5 Computed tomography (CT) scans and X-ray imaging are commonly used by radiologists in preoperative imaging for total joint arthroplasty (TJA) and cannot only detect IFs, but also determine how clinically significant those findings are. 6 7 Hassebrock et al evaluated 573 patients who underwent computer-assisted (CA) TJA and reported at least one IF during preoperative CT or magnetic resonance imaging (MRI) in 262 (45.7%) of the cases. 7 Similarly, Tran et al reported incidentalomas through preoperative CT imaging in 740 (51.7%) of 1,432 CA TJA cases; 41 (5.5%) of those findings were considered to be significant.…”

“…7 Similarly, Tran et al reported incidentalomas through preoperative CT imaging in 740 (51.7%) of 1,432 CA TJA cases; 41 (5.5%) of those findings were considered to be significant. 6…”

Ultrasound evaluations and guided procedures of the painful joint arthroplasty

“…Total joint arthroplasty (TJA) is among the most common orthopedic surgeries performed for the highly effective treatment of osteoarthritis-related pain [1][2][3][4]. This pertains to mainly an elderly population in whom several common medical conditions may coexist, potentially increasing the risk of complications [4][5][6][7][8][9].…”