Readers' Pages

Sir,
To be honest i was disappointed with the paper on the above subject volume 94 No. 3 April 2012. As a reviewer of articles for a leading international Orthopedic journal these are my observations. The paper that gets published should satisfy the following criteria.
1. The conclusion drawn should be objective.
2. The paper must open new vistas.
3. The paper should challenge an existing concept.
4. There should be a take home message.
5. The conclusions must be unambiguous.
Now the introduction of the paper ' It is common practice to either obtain an x-ray immediately post-operatively or prior to hospital dis-charge. This often means mobilization or discharge may be delayed until an x-ray is taken'.
I do not understand how taking an immediate x-ray has anything to do with his discharge or how does it delay his mobilization. The statements are contradictory. X-ray in any institution does not take more than 15 minutes.
I conclusion drawn also contradicts itself by being grossly subjective. Namely "It should be noted however that early post-operative x-rays may be performed in situations where immediate feedback is needed. Such as to a training surgeon or to a more experienced surgeon who is still on the learning curve for using a particular implant"
This paper fails in all the 5 criterion's that i have listed.
My apologies for being critical.

Dear Sir

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.

Kind regards

Mr Anand Patel (ST3, RNOH rotation, Barnet Hospital)
Mr Simon Mellor (Consultant Orthopaedic Surgeon, Barnet Hospital)