• Lucy Clare Maling, John Martin Lynch, Robert William Walker, Mark Ross Norton, and Rory George Middleton.
• Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Trust, Truro, TR1 3LQ, United Kingdom. lucy.maling@nhs.net.
• Eur J Trauma Emerg Surg. 2022 Aug 1; 48 (4): 2915-2918.

PurposeHip 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).MethodsWe 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.Results18 (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).ConclusionUnless 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.© 2021. The Author(s).

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