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DOI: 10.1055/a-2333-1619
Is Immediate Postoperative Radiograph Necessary Following Robotic-Assisted Total Knee Arthroplasty?
Funding None.![](https://www.thieme-connect.de/media/jks/EFirst/lookinside/thumbnails/10-1055-a-2333-1619_24feb0019oa-1.jpg)
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.
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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References
- 1 Varacallo M, Johanson NA. Total Knee Arthroplasty (TKA) Techniques [Internet]. Treasure Island, FL:: StatPearls Publishing;; 2019
- 2 Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S. Projected increase in total knee arthroplasty in the United States - an alternative projection model. Osteoarthritis Cartilage 2017; 25 (11) 1797-1803
- 3 Chang MJ, Lim H, Lee NR, Moon YW. Diagnosis, causes and treatments of instability following total knee arthroplasty. Knee Surg Relat Res 2014; 26 (02) 61-67
- 4 Bautista M, Manrique J, Hozack WJ. Robotics in total knee arthroplasty. J Knee Surg 2019; 32 (07) 600-606
- 5 Deckey DG, Rosenow CS, Verhey JT. et al. Robotic-assisted total knee arthroplasty improves accuracy and precision compared to conventional techniques. Bone Joint J 2021; 103-B (6, Supple A): 74-80
- 6 Aljawder A, Alomran D, Alayyoub M, Alkhalifa F. Immediate postoperative portable radiograph after total knee replacements: a necessity or a burden?. Open Orthop J 2018; 12 (01) 173-179
- 7 Ververeli PA, Masonis JL, Booth RE, Hozack WJ, Rothman RH. Radiographic cost reduction strategy in total joint arthroplasty. A prospective analysis. J Arthroplasty 1996; 11 (03) 277-280
- 8 Glaser D, Lotke P. Cost-effectiveness of immediate postoperative radiographs after uncomplicated total knee arthroplasty: a retrospective and prospective study of 750 patients. J Arthroplasty 2000; 15 (04) 475-478
- 9 Birir A, Amen TB, Varady NH, Chen AF. Clinical efficacy and cost-effectiveness of postoperative radiographs after total knee arthroplasty. Knee 2021; 32: 97-102
- 10 Brown ML, Michel D, Narayanan A, McCauley JC, Bugbee WD. Are immediate postoperative X-Rays valuable in evaluating complications of primary total hip arthroplasty?. Arthroplasty 2022; 4 (01) 44
- 11 Hart AA, DeMik DE, Brown TS, Noiseux NO. Routine radiographs after total joint arthroplasty: is there clinical value?. J Arthroplasty 2021; 36 (07) 2431-2434
- 12 Alden KJ, Duncan WD, Trousdale RT, Pagnano MW, Haidukewych GJ. Intraoperative fracture during primary total knee arthroplasty. Clin Orthop Relat Res 2010; 468 (01) 90-95
- 13 Smith TJ, Siddiqi A, Forte SA. et al. Periprosthetic fractures through tracking pin sites following computer navigated and robotic total and unicompartmental knee arthroplasty: a systematic review. JBJS Rev 2021; 9 (01) 00091
- 14 Hohmann E, Bryant A, Reaburn P, Tetsworth K. Does posterior tibial slope influence knee functionality in the anterior cruciate ligament-deficient and anterior cruciate ligament-reconstructed knee?. Arthroscopy 2010; 26 (11) 1496-1502
- 15 Moskal JT, Diduch DR. Postoperative radiographs after total knee arthroplasty: a cost-containment strategy. Am J Knee Surg 1998; 11 (02) 89-93
- 16 Moussa ME, Malchau H, Freiberg AA, Kwon YM. Effect of immediate postoperative portable radiographs on reoperation in primary total knee arthroplasty. Orthopedics 2014; 37 (09) e817-e821
- 17 Kosashvili Y, Alvi M, Mayne IP, Safir O, Gross A, Backstein D. Immediate recovery room radiographs after primary total knee arthroplasty: why do we keep doing them?. Int Orthop 2010; 34 (08) 1167-1173
- 18 Lavernia CJ, Hernandez RA, Rodríguez JA. Perioperative X-rays in arthroplasty surgery. J Arthroplasty 1999; 14 (06) 669-671
- 19 Khlopas A, Sodhi N, Sultan AA, Chughtai M, Molloy RM, Mont MA. Robotic arm-assisted total knee arthroplasty. J Arthroplasty 2018; 33 (07) 2002-2006
- 20 Mettler Jr FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 2008; 248 (01) 254-263
- 21 Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ:: Lawrence Erlbaum Associates;; 1988