Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Trust, Truro, TR1 3LQ, United Kingdom.
Conquest Hospital, East Sussex Healthcare NHS Trust, Hastings, TN37 7RD, United Kingdom.
Eur J Trauma Emerg Surg. 2022 Aug;48(4):2915-2918. doi: 10.1007/s00068-021-01605-3. Epub 2021 Jan 22.
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).
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.
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).
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.
髋关节半髋关节置换术（HA）是一种常见的手术。术后 X 光片是髋关节骨折常规治疗路径的一部分，尽管患者通常在接受该检查前就已开始活动。本研究旨在为优化患者安全和在国民保健制度（NHS）内分配有限资源提供实用临床改变的证据。
我们对 1563 例 HA 手术进行了回顾性数据库审查，以评估常规检查 X 光片是否对患者术后护理有重要作用。
18 例（1.2%）机械并发症导致在指数手术后 6 周内再次手术。均为脱位。其中 10 例术后 X 光片正常，5 例在 X 光片检查前有记录提示怀疑脱位。术后检查 X 光片仅在 3 例患者（0.2%）中明确识别出脱位。这 3 例患者均因认知障碍（AMTS 0/10）而术前卧床且无法交流。
除非患者术前卧床且认知障碍，否则 HA 手术后常规进行术后 X 光检查对临床益处不大，但可能对患者和 NHS 造成相当大的风险。一种实用的折衷方法是进行术中透视成像。
