Economic Feasibility of Routine First Postoperative Radiographs in Minimally Invasive Bunion Surgery.

Background: Orthopaedic surgical interventions are often costly, not only due to the procedures themselves, but also due to the need for frequent follow-up and imaging tests. Recent orthopaedic literature across several subspecialties has produced evidence suggesting that routine immediate postoperative radiographs do not provide any clinical advantage to justify their costs. This study aims to evaluate the economic feasibility of first postoperative radiographs after minimally invasive (MIS), fourth-generation MIS transverse double osteotomy for treatment of hallux valgus. Methods: We retrospectively evaluated patients with hallux valgus treated with fourth-generation MIS transverse double osteotomy between January 2019 and December 2021. Medical records were reviewed to assess changes in management following initial radiographs taken on average 1.38 ± 0.83 weeks after surgery. Direct costs of radiographs at the first postoperative visit (FPOV) were estimated using 2025 Medicare Fee Schedule data (HCPCS Code 73630), United Healthcare cost estimator website (zip code 33146), and multiple locally available public self-pay resources. National costs were estimated using Medicare data for the estimated 110,000 to 220,000 annual bunion procedures performed in the United States. Results: A total of 245 patients were included in our analysis. Four patients (1.6%, 95% CI 0.64%-4.12%) had an FPOV radiographic finding that warranted a change in management. Reasons included 1 (0.4%) loss of reduction of the first metatarsal osteotomy, 1 (0.4%) fracture through the Akin proximal phalanx osteotomy, and 2 (0.8%) subluxations of lesser toes fixated via K-wire. The cost per 3-view radiograph of the foot ranged from $31.68 to $106, depending on provider and payment type. National costs of routine radiographs for MIS bunion were estimated to be between $3.5 million to $23.3 million annually. Conclusion: Routine radiographs after fourth-generation MIS transverse double osteotomy surgery at FPOV rarely result in a change of management. In patients without clinically visible signs or symptoms warranting intervention, radiographs in the FPOV are rarely justified for MIS bunionectomy patients. We recommend physical evaluation at FPOV but suggest that substantial health care expenses could be saved by removing unnecessary FPOV radiographic analysis. Level of Evidence: Level IV, therapeutic/economic case series.