Routine Post-operative Radiographs Following Hip Hemiarthroplasty: Is It a Necessity?

Kavyansh Bhan,Mahesh Pimplé,Basharat Ghafoor Khan,Kamrul Hasan,Hassan Shafiq

doi:10.7759/cureus.19049

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.

Highlights

With an annual incidence of 1.6 million fractures, estimated to rise to more than 7 million by 2050, femoral neck fractures are one of the most common fractures treated by an orthopaedic surgeon [1,2]
We aim to analyze whether routine recommendation of post-operative radiographs following HA affects the clinical outcome, and whether it is effective in identifying potential complications which may be made worse by mobilisation before the patient reports any symptoms
Eight patients had no post-operative radiograph on the Picture Archiving and Communication System (PACS) system of the hospital

Summary

Introduction

With an annual incidence of 1.6 million fractures, estimated to rise to more than 7 million by 2050, femoral neck fractures are one of the most common fractures treated by an orthopaedic surgeon [1,2]. The National Institute of Health and Care Excellence (NICE) in the United Kingdom (UK) has laid down clear guidelines regarding surgical treatment of intracapsular femoral neck fractures. They have recommended that THR be offered to all patients who are able to independently mobilise outdoors with no more than the use of a stick and have no diagnosed cognitive impairment [4]. We aim to analyze whether routine recommendation of post-operative radiographs following HA affects the clinical outcome, and whether it is effective in identifying potential complications which may be made worse by mobilisation before the patient reports any symptoms. This study was conducted at a District General Hospital (DGH) in the Greater London region which is a frailty hip fracture centre and accepts patients with hip fractures from a catchment population of more than 2.6 million

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