Interpretation by radiologists of orthopedic total joint radiographs: is it necessary or cost-effective?

OBJECTIVE To examine the necessity and cost-effectiveness of interpretation by radiologists of orthopedic radiographs obtained for patients who undergo total hip or knee replacement. DESIGN A prospective study. Serial preoperative and postoperative x-ray films of the joint in patients scheduled to undergo total hip or knee joint replacement during one calendar year were interpreted by both radiology and orthopedic department staff and compared. Intraoperative findings were used to confirm the radiologic interpretation. The follow-up was 1 year. SETTING A university teaching hospital. INTERVENTIONS Primary or revision total hip or knee replacement. MAIN OUTCOME MEASURES Differences in interpretation of radiographs by radiologists and orthopedic surgeons for any of the four procedures. A change in orthopedic management. RESULTS For preoperative radiographs, there were no discrepancies between the radiologists and orthopedic surgeons with respect to primary joint replacement. For 100 revision procedures there were 15 discrepancies, but in all cases the orthopedic surgeon's interpretation proved to be correct. For the postoperative radiographs, there were no discrepancies in the group of revision hip replacements. For the other three groups there were a total of six discrepancies and in all cases the orthopedic surgeon's interpretation was correct. In two cases conditions were present that were not recognized by staff from either the radiology department or orthopedic department. CONCLUSION Interpretation by radiologists of total joint radiographs in patients who undergo primary or revision total hip or knee replacement arthroplasty is not necessary or cost-effective.