Incidental findings in preoperative computed tomography images of robotic-assisted total joint replacement: a multi-center retrospective study.

Abstract

Background: The majority of robot-assisted total joint arthroplasties necessitate preoperative computed tomography (CT) scans. Incidental findings in these CT scans can introduce complexity into clinical treatment decisions. Consequently, this study sought to document the nature and frequency of incidental findings identified in preoperative CT imaging conducted for robot-assisted total joint arthroplasty, along with their impact on planned surgical procedures.

Methods: This investigation constitutes a retrospective review encompassing patients who underwent primary robot-assisted total hip arthroplasty between January 2020 and January 2022 at the Second Affiliated Hospital of Xi'an Jiaotong University, the First Affiliated Hospital of Peking University, and Nanfang Hospital. It also includes patients who underwent robot-assisted total knee arthroplasty during the same period at the Second Affiliated Hospital of Xi'an Jiaotong University, the Third Affiliated Hospital of Peking University, Nanfang Hospital, and the Second Affiliated Hospital of Zhejiang University. All CT examinations were initially interpreted by proficient musculoskeletal radiologists. Subsequently, the findings in the examination reports, whether significant or non-significant, were compiled and categorized.

Results: A total of 218 patients, median age 63, were evaluated; 90 had incidental findings (41.3%), with 56 (25.7%) significant. Males were more likely to have findings (P = 0.001). Nine needed additional imaging, and five required intervention.Our study highlights the impact of unexpected CT findings on surgical planning, which can delay or cancel surgeries and affect patient outcomes. It also urges surgeons to review medical histories and perform thorough examinations before surgery to prevent serious consequences.

Conclusions: Radiologists often find incidental findings in preoperative CT scans for robot-assisted joint arthroplasty, with a 41.3% incidence rate. About 25.7% of these findings need physician follow-up, and under 5% require intervention, potentially causing delays or cancellations of procedures, while undetected findings could lead to fatal outcomes.Unexpected preoperative CT findings can enhance patient management and prevent complications, necessitating their inclusion in surgical protocols. Systematic assessment improves safety and outcomes, urging surgeons to review medical history and perform thorough examinations pre-surgery.

Clinical trial registration: Clinical trial registration time: 19/05/2022, clinical trial registration number: ChiCTR2200060115.