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Use radiography rarely, not routinely, for hip hemiarthroplasty
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 patien...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820819/ https://www.ncbi.nlm.nih.gov/pubmed/33481040 http://dx.doi.org/10.1007/s00068-021-01605-3 |
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author | Maling, Lucy Clare Lynch, John Martin Walker, Robert William Norton, Mark Ross Middleton, Rory George |
author_facet | Maling, Lucy Clare Lynch, John Martin Walker, Robert William Norton, Mark Ross Middleton, Rory George |
author_sort | Maling, Lucy Clare |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7820819 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-78208192021-01-22 Use radiography rarely, not routinely, for hip hemiarthroplasty Maling, Lucy Clare Lynch, John Martin Walker, Robert William Norton, Mark Ross Middleton, Rory George Eur J Trauma Emerg Surg Original Article 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. Springer Berlin Heidelberg 2021-01-22 2022 /pmc/articles/PMC7820819/ /pubmed/33481040 http://dx.doi.org/10.1007/s00068-021-01605-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Maling, Lucy Clare Lynch, John Martin Walker, Robert William Norton, Mark Ross Middleton, Rory George Use radiography rarely, not routinely, for hip hemiarthroplasty |
title | Use radiography rarely, not routinely, for hip hemiarthroplasty |
title_full | Use radiography rarely, not routinely, for hip hemiarthroplasty |
title_fullStr | Use radiography rarely, not routinely, for hip hemiarthroplasty |
title_full_unstemmed | Use radiography rarely, not routinely, for hip hemiarthroplasty |
title_short | Use radiography rarely, not routinely, for hip hemiarthroplasty |
title_sort | use radiography rarely, not routinely, for hip hemiarthroplasty |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820819/ https://www.ncbi.nlm.nih.gov/pubmed/33481040 http://dx.doi.org/10.1007/s00068-021-01605-3 |
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