Radiographs are routinely used to evaluate patients postoperatively after total knee arthroplasty, but no evidence-based guidelines exist regarding their use. The purpose of this study is to quantify the use of radiographs within 2 years of primary total knee arthroplasty by one surgeon and to determine if routine studies in asymptomatic patients altered patient management.
Patients undergoing consecutive primary total knee arthroplasties between 2008 and 2010 were identified. Patients undergoing revision or additional simultaneous procedures or those with less than 6 months of radiographic follow-up were excluded. Operative and clinic notes, radiographs, and radiology reports were reviewed.
A total of 263 patients were identified; each patient had an average of 13.5 ± 3.8 individual radiographs obtained in 6.5 ± 1.7 series. Twelve radiographic series were noted to have abnormal findings by either the attending surgeon or by radiology report. Three of these patients underwent reoperation directly related to the findings; 2 for deep infections and 1 for extensor mechanism disruption. All 3 patients had reported abnormal symptoms when their films were obtained. The remaining 9 abnormal radiographic findings included focal lucencies or osteolysis, asymmetric spacer wear, a healing stress fracture, an inferior patellar avulsion fracture, and heterotopic ossification. No patient had symptoms attributable to these findings when the radiographs were obtained, and in no case was the management altered based on these finding.
This study suggests that the observed frequency of routine postoperative radiographs in asymptomatic patients may not be necessary in the first 2 years after primary total knee arthroplasty.