We read this paper with great interest and accept that early mechanical failure following an uncomplicated TKR is very rare. However the does not change the fact that the trust is held accountable for any intervention performed on a patient during their stay in hospital and any complications that may have arisen as a consequence.
While we would not condone defensive medicine we consider the post-operative radiographs crucial evidence as to the exact nature of the intervention performed on the patient prior to discharge. They are an essential internal audit process for consultants and trainees alike to reflect on their practice, rule out intra-operative surgical error and ensure patients are safely discharged.
The trust cannot be held accountable if a patient attends their first post-operative clinic visit with complications such as a peri-prosthetic fracture or implant failure which may have occurred at home since discharge, if post-operative radiographs are cleared prior to discharge. For this reason, we do not agree that the first x-ray should be delayed until the first post-operative clinic visit.
Mr Anand Patel (ST3, RNOH rotation, Barnet Hospital)
Mr Simon Mellor (Consultant Orthopaedic Surgeon, Barnet Hospital)