Thursday, November 22, 2012

Immediate Postoperative Radiographs After Shoulder Arthroplasty Are Often Poor Quality and Do Not Alter Care CORR

Our ability to continue to provide the best care to our patients requires that we focus on every aspect of the value equation: benefit/cost. The authors of this paper do just that – they ask are recovery room x-rays worth the money? In their experience a single underpenetrated internal rotation view of the shoulder taken in the recovery room did not change their postoperative care or serve as a useful baseline for follow-up studies. The average cost of these films was $228/patient. An example might be something like this

 We agree that such a film is of limited value. By contrast, they found films in multiple projections (internal rotation and external rotation AP, scapular Y, and axillary views) taken 2-7 weeks after surgery to be of greater use, although neither the cost nor the value of these films was documented.

Our experience is a bit different. First of all many of our patients leave town on discharge, so that the opportunity to obtain a film in the weeks after surgery is limited. Secondly we carefully position the patient for an AP in the plane of the scapula and an axillary view, obtaining high quality films that not only confirm the desired position and relationship of the components, but also serve as a baseline for followup studies.

Below is an example of PACU radiographs on a patient from the Southeastern United States who came to Seattle this week for a ream and run procedure.

These views enabled us to verify the excellence of the reshaping of the glenoid, the position of the implant in the humeral shaft, the relation of the humeral head to the glenoid, and the absence of fractures. We were able to provide copies of these films to the patient and to review them with him and his wife before they left the medical center several days after surgery. They will hand carry them to show his referring physician back home.

So the title of this paper is a bit of an over generalization. The data apply to the specific practice of the authors.

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