Cost-effectiveness of screening x-rays at admission to acute rehabilitation after joint replacement surgery: a retrospective chart review.

OBJECTIVE: To investigate the cost-effectiveness of performing routine screening x-rays for patients on admission to an acute rehabilitation facility, after hip or knee replacement surgery, by reviewing the overall incidence of abnormal radiographic findings and determining their impact on patient care and outcome.

DESIGN: A retrospective chart review study, in which 592 patients were admitted, after hip or knee replacement surgery, to three acute inpatient rehabilitation facilities under one system.

RESULTS: Eight of 592 admissions revealed abnormal screening x-rays, for an overall incidence of 1.35%. All of the eight abnormal radiologic cases remained medically stable throughout their acute rehabilitation stay. The abnormalities did not alter the patients' medical management or length of stay. One case, which had demonstrated normal admission films, revealed a dislocated hip prosthesis on a follow-up x-ray, which was obtained as a result of new onset hip pain. The patient was subsequently transferred back to the acute care hospital for surgical correction.

CONCLUSIONS: The authors found a relatively low incidence of abnormal admission x-ray findings; furthermore, the detection of abnormal admission films did not alter patient care or outcome. The results suggested that performing routine admission radiologic studies on all patients after joint replacement surgery or hemiarthroplasty may not be a cost-effective screening tool in rehabilitation.