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Gan CJH, Zhuang X, Mahmood DTFB, Chua ECP. To pass or not to pass? Determining the acceptability of anteroposterior and lateral knee radiographs. Radiography (Lond) 2024; 30:1578-1587. [PMID: 39395216 DOI: 10.1016/j.radi.2024.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 09/20/2024] [Accepted: 09/29/2024] [Indexed: 10/14/2024]
Abstract
INTRODUCTION The criteria for determining the acceptability of total knee replacement (TKR) radiographs are not established in current clinical practice. In TKR patients, the implant components replaced the anatomical landmarks, making it more difficult for radiographers to determine the degree of rotation. This study aims to establish an acceptable range of knee rotation for TKR radiographs. METHODS Rejected TKR radiographs (199 AP and 186 lateral) were analysed retrospectively. Radiographers objectively measured rotation on the radiographs. A subset of 46 AP and 46 lateral radiographs were rated by orthopaedic surgeons for rotation and diagnostic value. Inter-rater reliability (IRR) of radiographic measurements and surgeons' ratings were analysed using Bland-Altman and Cohen's kappa, respectively. Spearman's rank-order correlation and Receiver Operator Characteristic analyses were used to determine the correlation and diagnostic performance of the radiographic measurements against the surgeon's ratings. RESULTS Strong IRR was observed for the radiographic measurements. Only slight to fair agreement was observed for the surgeons' rotation and diagnostic value ratings of the radiographs. Moderate to strong correlation was observed between the radiographic measurements and the surgeons' ratings. The radiographic measurements provided acceptable to excellent discrimination of acceptable and unacceptable radiographs. The acceptable range of measured rotation for usability was AP: 0-5.29 mm and lateral: 0-6.01 mm. CONCLUSION The proposed measurement methods and the established rotation range could potentially be used by radiographers in clinical practice to determine the acceptability of TKR radiographs. Follow-up studies could investigate uncommon knee implants and seek consensus across different institutions on the acceptable degree of rotation. IMPLICATIONS FOR PRACTICE The proposed method suggests that accepting radiographs within the threshold (AP: 5.29 mm, lateral: 6.01 mm) reduces repeated examination and radiation exposure and improves imaging efficiency.
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Affiliation(s)
- C J H Gan
- Singapore Institute of Technology, 10 Dover Drive 138683, Singapore.
| | - X Zhuang
- Singapore Institute of Technology, 10 Dover Drive 138683, Singapore.
| | - D T F B Mahmood
- Sengkang General Hospital, 110 Sengkang East Way 544886, Singapore.
| | - E C-P Chua
- Singapore Institute of Technology, 10 Dover Drive 138683, Singapore.
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Giordano JR, Bartlett L, Huyke F, Sadh P, Thompson K, Ajah O, Danoff J. Is Immediate Postoperative Radiograph Necessary Following Robotic-Assisted Total Knee Arthroplasty? J Knee Surg 2024; 37:851-855. [PMID: 38788783 DOI: 10.1055/a-2333-1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The necessity of immediate postoperative radiographs following total knee arthroplasty (TKA) has long been debated. With the increasing use of robotic-assisted TKA (RTKA), and thus more precise implant placement, the need for immediate postoperative radiographs to determine implant positioning may be unnecessary. We sought to evaluate implant position on the immediate postoperative radiographs following RTKA to determine their necessity. A retrospective review of 150 RTKAs was performed. The posterior slopes for all TKAs were recorded based on the preoperative three-dimensional template. Additionally, two independent trained researchers (J.G./L.B.) each measured the posterior slope of the postoperative day 0 (POD0) radiograph and postoperative week 2 radiograph. The difference in posterior slope measurement between template and POD0, between template and postoperative week 2, and between POD0 and postoperative week 2 was calculated. Of the 150 TKAs performed, there were no periprosthetic fractures found on the POD0 radiograph. The mean difference between the templated posterior slope and measured posterior slope on POD0 was 0.04 degrees (standard deviation [SD], 1.01; p = 0.615). There was a weak correlation between the two values (rs [95% confidence interval (CI)], 0.38 [0.21, 0.53]). When comparing the template to the postoperative week 2 radiographs, there was a mean difference of 0.02 degrees (SD, 0.48; p = 0.556). However, a moderate to strong correlation was noted (rs [95% CI], 0.71 [0.61, 0.79]). Comparison of the mean posterior slope from POD0 radiograph to that of postoperative week 2 radiograph showed a mean difference of 0.06 degrees (SD, 1.0; p = 0.427). A weak correlation was found between these two values (rs [95% CI], 0.43 [0.26, 0.56]). Given the accuracy and precision of RTKA, along with the ability to decrease cost and radiation, immediate postoperative radiograph may be unnecessary, when pertaining to the uncomplicated RTKA. However, if there is concern for intraoperative fracture, long stems placed in a revision arthroplasty, or other intraoperative complications, then postoperative radiographs are encouraged.
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Affiliation(s)
- Joshua R Giordano
- Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntington, New York
| | - Lucas Bartlett
- Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntington, New York
| | - Fernando Huyke
- Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntington, New York
| | - Puru Sadh
- Zucker School of Medicine at Hofstra, Hempstead, New York
| | - Kiara Thompson
- Zucker School of Medicine at Hofstra, Hempstead, New York
| | - Obinnah Ajah
- Zucker School of Medicine at Hofstra, Hempstead, New York
| | - Jonathan Danoff
- Department of Orthopaedic Surgery, Northwell Health, North Shore University Hospital, Manhasset, New York
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Moses AM, Guier C, Wright TW, King JJ, Hattrup SJ, Sperling J, Sanchez Sotelo J, Schoch BS. Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty. J Shoulder Elbow Surg 2022; 32:e235-e240. [PMID: 36460261 DOI: 10.1016/j.jse.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/30/2022] [Accepted: 10/20/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Intraoperative complications after shoulder arthroplasty (SA) are uncommon, yet surgeons continue to obtain immediate postoperative radiographs despite prior literature questioning the efficacy of these images. There is a paucity of literature describing the role of immediate postoperative radiographs in revision SA. This study aimed to evaluate the utility of immediate postoperative radiographs in identifying intraoperative complications leading to a change in care after primary or revision SA. We hypothesized that routine postoperative ("survey") radiographs would not provide a high diagnostic yield in identifying early complications requiring a change in postoperative management. METHODS A retrospective review of 4063 SAs (1298 primary anatomic total shoulder arthroplasties [aTSAs], 2162 primary reverse shoulder arthroplasties [RSAs], 129 revision aTSAs, and 474 revision RSAs) was performed from a multi-institutional arthroplasty database. All shoulders were evaluated with a single immediate postoperative (survey) radiograph that was read by a musculoskeletal radiologist and by the treating orthopedic surgery team. The radiology reports of all 4063 immediate postoperative radiographs were reviewed to determine whether complications had been identified. For patients in whom complications were identified, the medical record was then reviewed to determine whether the survey radiograph resulted in a return to the operating room or a change in management between the surgical procedure and the first postoperative clinic visit with radiographic evaluation. RESULTS Complications were reported by a radiologist on the basis of immediate postoperative radiographs in 10 of 4063 shoulders (0.2%, or 1 of every 500 arthroplasties). Complications were reported after 4 primary RSAs, 4 revision aTSAs, and 2 revision RSAs; no complication was reported after any of the primary aTSAs. Of the 10 complications, only 3 were unknown to the treating surgeon following the operation and none altered immediate postoperative management. Early complications were reported at a rate of 1% after revision arthroplasty vs. 0.1% after primary arthroplasty (P = .001). Additionally, revision aTSA was found to have a higher rate of complications reported on radiographs, with a rate of 3.1%, compared with revision RSA, at 0.4% (P = .021). CONCLUSION The radiology reports of routine immediate postoperative radiographs rarely identified postoperative complications (0.2%). In all cases, postoperative management remained unaltered until the time of the first postoperative visit. The value and medicolegal implications of immediate postoperative radiographs may inform the decision to abandon obtaining these studies routinely.
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Affiliation(s)
- Alex M Moses
- Department of Orthopedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Christian Guier
- Department of Orthopedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Thomas W Wright
- Department Orthopaedics Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department Orthopaedics Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Steven J Hattrup
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - John Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
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Bhan K, Hasan K, Khan BG, Shafiq H, Pimplé M. Routine Post-operative Radiographs Following Hip Hemiarthroplasty: Is It a Necessity? Cureus 2021; 13:e19049. [PMID: 34858741 PMCID: PMC8613712 DOI: 10.7759/cureus.19049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
Femoral neck fractures are one of the most common fractures treated by an Orthopaedic surgeon. Arthroplasty is the recommended management for intracapsular neck of femur fractures in the elderly population owing to the high risk of avascular necrosis of the femoral head following an internal fixation. Elderly patients with intracapsular fractures deemed high risk for anaesthesia (American Society of Anaesthesiology Grade more than 2) are recommended a hip hemiarthroplasty. Routine practice throughout the United Kingdom is to obtain a postoperative check radiograph for all hip hemiarthroplasty patients prior to their discharge from the hospital. This may be done for various reasons like checking the presence of any peri-prosthetic fracture, the position of the components along with the presence of any dislocation. However, it is unclear whether a radiograph is the sole identifier of such complications. Through this study, we aim to analyse whether routine recommendation of post-operative radiographs following hip hemiarthroplasty affects the clinical outcome, and whether it is effective in identifying potential complications before the patients report any signs or symptoms.
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Affiliation(s)
- Kavyansh Bhan
- Trauma and Orthopaedics, Barts Health NHS Trust, London, GBR
| | - Kamrul Hasan
- Trauma and Orthopaedics, Barts Health NHS Trust, London, GBR
| | | | - Hassan Shafiq
- Trauma and Orthopaedics, Barts Health NHS Trust, London, GBR
| | - Mahesh Pimplé
- Trauma and Orthopaedics, Barts Health NHS Trust, London, GBR
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Chiarlone F, Zanirato A, Cavagnaro L, Alessio-Mazzola M, Felli L, Burastero G. Acetabular custom-made implants for severe acetabular bone defect in revision total hip arthroplasty: a systematic review of the literature. Arch Orthop Trauma Surg 2020; 140:415-424. [PMID: 31960168 DOI: 10.1007/s00402-020-03334-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE The management of acetabular bone loss is a challenging problem in revision total hip arthroplasty (rTHA). The aim of this systematic review is to summarize and critically analyze indications, complications, clinical and radiological outcomes of custom-made acetabular components in rTHA. METHODS A systematic review of English literature was performed on Medline. Retrospective or prospective studies with minimum 2 years of follow-up (FU) were included. The PRISMA 2009 flowchart and checklist were considered to edit the review. Rates of intra- or post-operative complications, aseptic loosening (AL), periprosthetic joint infection (PJI), reoperations and re-revisions rates were extrapolated. RESULTS 18 articles with a level of evidence of IV were included. Six hundred and thirty-four acetabular custom components (627 patients) with a mean FU of 58.6 ± 29.8 months were analyzed. The studies showed good clinical and functional outcomes. Custom-made acetabular components allowed a stable fixation with 94.0 ± 5.0% survival rate. The estimated rate of re-operations and re-revisions were 19.3 ± 17.3% and 5.2 ± 4.7%, respectively. The incidence of PJI was 4.0 ± 3.9%. CONCLUSIONS The acetabular custom-made implants represent a reliable solution for pelvic discontinuity and particular cases of bone loss classified as Paprosky Type IIIA-B or type III-IV according to American Academy of Orthopaedic Surgeons system where the feature of the defect cannot be handled with standard implants. This strategy allows to fit the implant to the residual host bone, bypassing the bony deficiency and restoring hip biomechanics. Satisfactory clinical and radiological outcomes at mid-term follow-up are reported in literature.
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Affiliation(s)
- Francesco Chiarlone
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Andrea Zanirato
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
| | - Luca Cavagnaro
- Clinic Ortopedia e Traumatologia 2, Joint Replacement Unit, Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
| | - Mattia Alessio-Mazzola
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Lamberto Felli
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - Giorgio Burastero
- Clinic Ortopedia e Traumatologia 2, Joint Replacement Unit, Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy
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