Routine Early Post-operative X-Ray Following Partial Hip Replacement After Femoral Hip Fracture Is Unjustified: A Retrospective Study

Abstract

Background Routine early postoperative radiographs following hemiarthroplasty for femoral neck fractures are widely performed despite limited evidence supporting their clinical utility in asymptomatic patients. Objectives To determine whether routine early postoperative radiographs within the first three months after hemiarthroplasty influence clinical management or revision rates. Design A single-center retrospective cohort study conducted at a tertiary academic institution, including consecutive patients who underwent cementless hemiarthroplasty for intracapsular femoral neck fractures between January 2015 and December 2024. Methods Patients were included if they attended routine outpatient follow-up between six weeks and three months postoperatively with available AP and lateral radiographs, or if they underwent revision surgery during this period. Radiographs and medical records were reviewed to assess whether imaging findings altered clinical management, including weight-bearing recommendations or the need for revision surgery. Results A total of 1,303 patients were included. The median follow-up time was 52 days (IQR 42-68 days). Routine postoperative radiographs did not result in any change in management or revision surgery rates in asymptomatic patients. The observed proportion of patients in whom routine radiographs altered management was 0% (95% confidence interval: 0.0%-0.28%). Seventy reoperations occurred during the follow-up period; all these patients presented with symptoms through the emergency department prior to intervention. Conclusion Routine early postoperative radiographs after hemiarthroplasty for femoral neck fractures do not appear to influence clinical management in asymptomatic patients with satisfactory intraoperative imaging. A selective, symptom-driven imaging approach may safely reduce unnecessary radiation exposure and healthcare costs.