Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 4/2013

01-04-2013 | Clinical Research

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

Authors: Surena Namdari, MD, MSc, Jason E. Hsu, MD, Matthew Barron, BS, G. Russell Huffman, MD, MPH, David Glaser, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 4/2013

Login to get access

Abstract

Background

It is technically difficult to obtain high-quality, 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.

Results

All images in Group 1 were single-view radiographs (88% internal rotation), most were underpenetrated (71%); no images changed postoperative management or were considered adequate to serve as a baseline. Group 2 radiographs were multiview radiographs, and 83% were deemed adequate to serve as baseline radiographs. Radiographic interpretation of immediate postoperative radiographs did not change the clinical course or treatment. The charges billed from radiographic evaluation in this study were $64,524 for Group 1.

Conclusions

Routine PACU radiographs, in the absence of a specific indication, may result in poor-quality images. Elimination of these radiographs and radiographic interpretation after shoulder arthroplasty may reduce charges without changing clinical care.

Level of Evidence

Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
Barwood S, Setter KJ, Blaine TA, Bigliani LU. The incidence of early radiolucencies about a pegged glenoid component using cement pressurization. J Shoulder Elbow Surg. 2008;17:703–708.PubMedCrossRef
2.
Cheung E, Willis M, Walker M, Clark R, Frankle MA. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011;19:439–449.PubMed
3.
Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz SM. Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg. 2010;19:1115–1120.PubMedCrossRef
4.
Glaser D, Lotke P. Cost-effectiveness of immediate postoperative radiographs after uncomplicated total knee arthroplasty: a retrospective and prospective study of 750 patients. J Arthroplasty. 2000;15:475–478.PubMedCrossRef
5.
Lazarus MD, Jensen KL, Southworth C, Matsen FA 3rd. The radiographic evaluation of keeled and pegged glenoid component insertion. J Bone Joint Surg Am. 2002;84:1174–1182.PubMed
6.
Mercer D, Saltzman MD, Neradilek MB, Gilmer BB, Warme WJ, Matsen FA 3rd. A reproducible and practical method for documenting the position of the humeral head center relative to the scapula on standardized plain radiographs. J Shoulder Elbow Surg. 2011;20:363–371.PubMedCrossRef
7.
Mercer DM, Gilmer BB, Saltzman MD, Bertelsen A, Warme WJ, Matsen FA 3rd. A quantitative method for determining medial migration of the humeral head after shoulder arthroplasty: preliminary results in assessing glenoid wear at a minimum of two years after hemiarthroplasty with concentric glenoid reaming. J Shoulder Elbow Surg. 2011;20:301–307.PubMedCrossRef
8.
Moskal JT, Diduch DR. Postoperative radiographs after total knee arthroplasty: a cost-containment strategy. Am J Knee Surg. 1998;11:89–93.PubMed
9.
Mulhall KJ, Masterson E, Burke TE. Routine recovery room radiographs after total hip arthroplasty: ineffective for screening and unsuitable as baseline for longitudinal follow-up evaluation. J Arthroplasty. 2004;19:313–317.PubMedCrossRef
10.
Ndu A, Jegede K, Bohl DD, Keggi K, Grauer JN. Recovery room radiographs after total hip arthroplasty: tradition vs utility? J Arthroplasty. 2012;27:1051–1056.PubMedCrossRef
11.
Nho SJ, Frank RM, Verma NN, Romeo AA. Incidence of early development of radiolucent lines in keeled polyethylene glenoid components after total shoulder arthroplasty. Am J Orthop (Belle Mead NJ). 2010;39:333–337.
12.
Niskanen RO. Early repetitive radiography is unnecessary after an uncomplicated cemented hip or knee arthroplasty for osteoarthritis. Acta Orthop Belg. 2005;71:692–695.PubMed
13.
Saltzman MD, Mercer DM, Warme WJ, Bertelsen AL, Matsen FA 3rd. A method for documenting the change in center of rotation with reverse total shoulder arthroplasty and its application to a consecutive series of 68 shoulders having reconstruction with one of two different reverse prostheses. J Shoulder Elbow Surg. 2010;19:1028–1033.PubMedCrossRef
14.
Szabo I, Buscayret F, Edwards TB, Nemoz C, Boileau P, Walch G. Radiographic comparison of flat-back and convex-back glenoid components in total shoulder arthroplasty. J Shoulder Elbow Surg. 2005;14:636–642.PubMedCrossRef
15.
Ververeli PA, Masonis JL, Booth RE, Hozack WJ, Rothman RH. Radiographic cost reduction strategy in total joint arthroplasty: a prospective analysis. J Arthroplasty. 1996;11:277–280.PubMedCrossRef
Metadata
Title
Immediate Postoperative Radiographs After Shoulder Arthroplasty Are Often Poor Quality and Do Not Alter Care
Authors
Surena Namdari, MD, MSc
Jason E. Hsu, MD
Matthew Barron, BS
G. Russell Huffman, MD, MPH
David Glaser, MD
Publication date
01-04-2013
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 4/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2551-9

Other articles of this Issue 4/2013

Clinical Orthopaedics and Related Research® 4/2013 Go to the issue

Symposium: Childhood Obesity and Musculoskeletal Problems

How Does Bone Quality Differ Between Healthy-weight and Overweight Adolescents and Young Adults?

Symposium: Childhood Obesity and Musculoskeletal Problems

Obesity Negatively Affects Spinal Surgery in Idiopathic Scoliosis

Symposium: Osteochondritis Dissecans

Three Osteochondritis Dissecans Lesions in One Knee: A Case Report

Clinical Research

Intraoperative Joint Gaps Affect Postoperative Range of Motion in TKAs With Posterior-stabilized Prostheses

Clinical Research

3-D CT is the Most Reliable Imaging Modality When Quantifying Glenoid Bone Loss

Symposium: Childhood Obesity and Musculoskeletal Problems

Childhood Obesity Is Associated With Increased Risk of Most Lower Extremity Fractures