The idiom “penny wise, pound foolish” certainly applies in this report of 2 cases of missed bone tumors that were present but not recognized on preoperative imaging prior to placement of patient-specific knee arthroplasties. The case report appeared in the December 2013 issue of The American Journal of Orthopedics. The term “non-diagnostic imaging,” itself a paradox, used in the context of preoperative imaging performed solely for the purpose of component templating for patient-specific instrumentation (PSI) and not intended to be diagnostic in purpose, would be anathematic to most radiologists and should be discarded as a concept.
Bearing in mind the costs incurred by the patient undergoing a total knee arthroplasty (TKA), such as professional consultation, preoperative magnetic resonance imaging, customized manufacture of the components, surgery and associated costs, and postoperative rehabilitation, the fee for a formal report by a musculoskeletal radiologist is comparatively minuscule. As correctly pointed out by the authors, the price associated with bypassing any assessment and missing malignant disease is far greater.
It is well recognized that unreported radiologic examinations can lead to misdiagnosis, compromised patient care, and liability concerns. As PSI is relatively new and has good potential to increase the accuracy, precision and efficiency of TKA, it is even more vital that this promising technology not be marred by disrepute due to possible devastating outcomes resulting from lack of a radiologic report. From the professional point of view of a radiologist, the issuance of a formal report is part and parcel of any radiological examination. I would argue that obtaining radiologic images without an accompanying report constitutes an incomplete study, and will not be in the best interest of patients.
Let the lessons learned from these 2 cases be a springboard to establish protocols for proper utilization of technologies involved in PSI for TKA and other orthopedic procedures. It is imperative to put into place mandatory reporting of all diagnostic images obtained for preoperative evaluation, particularly those that are meant to be sent directly to implant manufacturers for component design.
Menge TJ, Hartley KG, Holt GE. Patient-Specific Imaging and Missed Tumors: A Catastrophic Outcome. Am J Orthop. 2013;42(12):553-556.