An evaluation of routine post-operative radiographs following hip hemiarthroplasty

The incidence of hip fractures in patients over 65 is increasing in the UK contributing to significant financial and environmental burdens on the NHS. Routine post-operative radiographs are commonly performed after hip hemiarthroplasty to detect complications, despite limited evidence supporting their clinical value. As the NHS strives for greater cost efficiency and sustainability, this study aims to evaluate the utility and cost-effectiveness of these routine radiographs in identifying postoperative complications. A single-centre retrospective analysis was performed on all patients who underwent hip hemiarthroplasty over 12 months. Post-operative notes, clinical notes and imaging were analysed to identify complications occurring immediately and within 90 days post-operatively. A prospective analysis was conducted to measure the additional anaesthetic and radiographer time. 200 hip hemiarthroplasty operations were identified in the National Hip Fracture Database during the data collection period. 199 patients had no complications found on intra-operative, formal and imaging within 90 days post-operative. One patient experienced an intra-operative complication which was managed intra-operatively, post-operative imaging was satisfactory, and no complications were noted within the 90 days post-operative. 15 patients received formal departmental X-rays instead of intra-operative imaging, while 2 patients had both. 25 patients required further imaging after their initial post-operative X-ray, most commonly due to a fall (n=15) with no complications related to the original hemiarthroplasty. The time spent by the Radiographers from the initial call to the return to the department was an average time of 34.1 minutes and the additional time under anaesthesia was an average of 4.6 minutes. This study highlights the limited value of routine post-operative check radiographs following hip hemiarthroplasty. We propose that check radiographs be reserved for cases with a clear clinical indication thereby reducing costs to the NHS, optimising resource utilisation and improving patient care.