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

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

An Erratum to this article was published on 13 February 2013

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.

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Authors and Affiliations

  1. The Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Surena Namdari MD, MSc, Jason E. Hsu MD, G. Russell Huffman MD, MPH & David Glaser MD

  2. University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Matthew Barron BS

  3. Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, 1 Cupp Pavilion, 3900 Market Street, Philadelphia, PA, 19104, USA

    David Glaser MD

Authors
  1. Surena Namdari MD, MSc
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  2. Jason E. Hsu MD
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  3. Matthew Barron BS
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  4. G. Russell Huffman MD, MPH
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  5. David Glaser MD
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Corresponding author

Correspondence to David Glaser MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Penn Presbyterian Medical Center, Philadelphia, PA, USA.

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Namdari, S., Hsu, J.E., Barron, M. et al. Immediate Postoperative Radiographs After Shoulder Arthroplasty Are Often Poor Quality and Do Not Alter Care. Clin Orthop Relat Res 471, 1257–1262 (2013). https://doi.org/10.1007/s11999-012-2551-9

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  • DOI: https://doi.org/10.1007/s11999-012-2551-9

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