Routine Postoperative Radiographs Rarely Change Management After Uncomplicated Elective Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of Management-Change Rate and Cost.

Authors

Adam Friedman, Seth Spicer, Yeonji Kim, Tarius Hill, Kevin Kim, Sean McMillan

Published in

The Journal of arthroplasty. Nov 10, 2026. Epub Nov 10, 2026.

Abstract

Routine postoperative radiographs are standard practice following total joint arthroplasty, yet their clinical utility remains poorly defined, and evidence synthesizing this practice across hip and knee arthroplasty together remains limited.
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020-compliant systematic review and meta-analysis was conducted across five electronic databases through April 7, 2026. Eligible studies enrolled adults undergoing primary elective total hip or knee arthroplasty and reported management-change data following routine postoperative plain radiography. There were 17 studies that met inclusion criteria; thirteen studies (18 analysis units, N = 10,853 imaging encounters) contributed to the primary meta-analysis. Management change rate was pooled using a random-effects meta-analysis of proportions using a generalized linear mixed model with Knapp-Hartung confidence intervals. Pre-specified subgroup analyses were conducted by imaging context (inpatient versus outpatient) and arthroplasty type (total hip arthroplasty [THA] versus total knee arthroplasty [TKA]).
The pooled management change rate was 0.02% (95% confidence interval 0 to 0.34, I2 = 0%). There were no significant differences detected by imaging context (P = 0.691). All seven observed events occurred in the THA subgroup, with zero events across all ten TKA studies; the pre-specified subgroup-difference test did not converge, and a Fisher's exact sensitivity analysis indicated a significant difference (P < 0.001), a finding treated as hypothesis-generating rather than confirmatory given the extreme sparsity of events. The number needed to image was 5,555, corresponding to an estimated cost of $1,623,813 per management change.
Routine postoperative radiographs following elective hip and knee arthroplasty changed clinical management in approximately one in 5,555 imaging encounters, at a cost exceeding $1.6 million per management change, with no significant difference by imaging context. These findings do not support routine postoperative imaging in uncomplicated elective cases.

PMID:
43008904
Bibliographic data and abstract were imported from PubMed on 11 Nov 2026.

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