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J Knee Surg 2024; 37(12): 851-855
DOI: 10.1055/a-2333-1619
Original Article

Is Immediate Postoperative Radiograph Necessary Following Robotic-Assisted Total Knee Arthroplasty?

Joshua R. Giordano 
1   Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntington, New York
,
Lucas Bartlett
1   Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntington, New York
,
Fernando Huyke
1   Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntington, New York
,
Puru Sadh
2   Zucker School of Medicine at Hofstra, Hempstead, New York
,
Kiara Thompson 
2   Zucker School of Medicine at Hofstra, Hempstead, New York
,
Obinnah Ajah
2   Zucker School of Medicine at Hofstra, Hempstead, New York
,
Jonathan Danoff
3   Department of Orthopaedic Surgery, Northwell Health, North Shore University Hospital, Manhasset, New York
› Author Affiliations
Funding None.
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Abstract

The necessity of immediate postoperative radiographs following total knee arthroplasty (TKA) has long been debated. With the increasing use of robotic-assisted TKA (RTKA), and thus more precise implant placement, the need for immediate postoperative radiographs to determine implant positioning may be unnecessary. We sought to evaluate implant position on the immediate postoperative radiographs following RTKA to determine their necessity. A retrospective review of 150 RTKAs was performed. The posterior slopes for all TKAs were recorded based on the preoperative three-dimensional template. Additionally, two independent trained researchers (J.G./L.B.) each measured the posterior slope of the postoperative day 0 (POD0) radiograph and postoperative week 2 radiograph. The difference in posterior slope measurement between template and POD0, between template and postoperative week 2, and between POD0 and postoperative week 2 was calculated. Of the 150 TKAs performed, there were no periprosthetic fractures found on the POD0 radiograph. The mean difference between the templated posterior slope and measured posterior slope on POD0 was 0.04 degrees (standard deviation [SD], 1.01; p = 0.615). There was a weak correlation between the two values (rs [95% confidence interval (CI)], 0.38 [0.21, 0.53]). When comparing the template to the postoperative week 2 radiographs, there was a mean difference of 0.02 degrees (SD, 0.48; p = 0.556).  However, a moderate to strong correlation was noted (rs [95% CI], 0.71 [0.61, 0.79]). Comparison of the mean posterior slope from POD0 radiograph to that of postoperative week 2 radiograph showed a mean difference of 0.06 degrees (SD, 1.0; p = 0.427). A weak correlation was found between these two values (rs [95% CI], 0.43 [0.26, 0.56]). Given the accuracy and precision of RTKA, along with the ability to decrease cost and radiation, immediate postoperative radiograph may be unnecessary, when pertaining to the uncomplicated RTKA. However, if there is concern for intraoperative fracture, long stems placed in a revision arthroplasty, or other intraoperative complications, then postoperative radiographs are encouraged.

Keywords

total knee arthroplasty - robotics - radiograph - postoperative


Publication History

Received: 11 February 2024

Accepted: 22 May 2024

Accepted Manuscript online:
24 May 2024

Article published online:
12 June 2024

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