JOURNAL ARTICLE

Use radiography rarely, not routinely, for hip hemiarthroplasty

Lucy Clare Maling, John Martin Lynch, Robert William Walker, Mark Ross Norton, Rory George Middleton
European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society 2021 January 22
33481040

PURPOSE: Hip hemiarthroplasty (HA) is a commonly performed operation. A post-operative radiograph forms part of the routine hip fracture pathway, although patients are often mobilised prior to this investigation. This study seeks to provide evidence for a pragmatic clinical change to optimise patient safety and allocate limited resources within the National Health Service (NHS).

METHODS: We undertook a retrospective database review of 1563 HA procedures to assess whether the routine ordering of check radiographs played an important role in a patient's post-operative care.

RESULTS: 18 (1.2%) mechanical complications led to a return to theatre within 6 weeks of the index procedure. All were dislocations. Ten had a normal post-operative radiograph and five had documented suspicion of dislocation prior to radiography. The post-operative check radiograph was the sole identifier of dislocation in only three patients (0.2%). All three of these patients were pre-morbidly bed bound and non-communicative due to cognitive impairment (AMTS 0/10).

CONCLUSION: Unless a patient is pre-morbidly bed bound and cognitively impaired, routine post-operative radiography following HA surgery is of little clinical benefit, yet may carry considerable risk to the patient and cost to the NHS. A pragmatic compromise is to perform intra-operative fluoroscopic imaging.

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