Utility of postoperative radiography in routine primary total shoulder arthroplasty.
BACKGROUND
The medical relevance and cost-benefit of routine radiographs after primary anatomic total shoulder arthroplasty (TSA) up to a year postoperatively are unknown. This study was performed to assess the medical relevance and cost-benefit of radiography after TSA during the first postoperative year.


METHODS
During the period 2010 to 2015, 160 consecutive patients undergoing anatomic TSA by a single fellowship-trained surgeon had radiographs obtained at 2 weeks, 6 weeks, 4 months, and 1 year postoperatively. Radiographs and clinic notes were assessed to determine if a change in postoperative care happened because of radiographic findings, including postoperative fracture, hardware complication, or any concerning radiographic feature. Cost data and amount billed were obtained.


RESULTS
Patients underwent radiography at 1.8 ± 0.2 weeks, 6.5 ± 1.2 weeks, 14.9 ± 2.9 weeks, and 46.8 ± 19.5 weeks postoperatively. Findings on the radiologist's reading were normal/unremarkable for 100.0%, 96.8%, 95.9%, and 95.2%, respectively, at each visit. Results were documented in the note for 92.5%, 97.4%, 98.0%, and 92.4%, respectively, at each visit. Review of the radiographs yielded no change in management based on these parameters. The amount billed for radiographs was $284,281 ($1776.76 per patient).


CONCLUSIONS
A lack of clinically meaningful impact from routine postoperative radiography does not justify the per-patient expense, as routine imaging did not cause a change in postoperative management. The available data suggest that routine radiographs after primary anatomic TSA may be unnecessary or perhaps the described frequency in which radiographs are obtained is in excess.
['Dempsey|Ian J|IJ|', 'Kew|Michelle E|ME|', 'Cancienne|Jourdan M|JM|', 'Werner|Brian C|BC|', 'Brockmeier|Stephen F|SF|']
D000368:Aged D000072228:Arthroplasty, Replacement, Shoulder D005260:Female D006801:Humans D007592:Joint Diseases D008297:Male D008875:Middle Aged D011182:Postoperative Care D011183:Postoperative Complications D011859:Radiography D012189:Retrospective Studies D013997:Time Factors
utility radiography Primary total shoulder arthroplasty X-ray cost-effectiveness health care economics