Imaging of the Painful Hip Arthroplasty

Hargunani, Rikin; Madani, Hardi; Khoo, Michael; Fotiadou, Anastasia; Pressney, Ian; Calleja, Michele; O’Donnell, Paul

doi:10.1016/j.carj.2015.11.003

Cited by 21 publications

(25 citation statements)

References 40 publications

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“…Radiographs are also useful for follow up to assess for post-operative complications. These complications can be classified according to their radiological appearance: (i) peri-prosthetic lucencies that could indicate aseptic loosening, infection, or deposition of metallic wear in peri-prosthetic tissues (ii) sclerosis and bone proliferation (iii) component failure/fracture that can be seen in cases of linear wear, dislocation and peri-prosthetic fractures (1, 2, 9, 10). Serial radiographs are the most effective method of detecting prosthesis loosening.…”

Section: Overview Of Imaging Modalitiesmentioning

confidence: 99%

Radiological Imaging Evaluation of the Failing Total Hip Replacement

Mushtaq

Gooding

et al. 2019

Front. Surg.

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Total hip replacements (THR) have been performed in the UK from the 1960s and since then we have seen surgical techniques, the design of implants, and imaging modalities rapidly develop. This paper will aim to review the different complications and imaging appearance which help to evaluate each problem. As for all investigations for bone and joints, a radiograph is the first imaging to be performed for any patient with a THR and can detect a majority of complications. CT is relatively low-cost, simple to perform and easily available making it an excellent tool to supplement radiographs when trying to evaluate a hip prosthesis. Single photon emission computed tomography with CT (SPECT-CT) is an emerging modality which has shown to combine the sensitivity that bone scintigraphy offers with the high specificity of CT. SPECT imaging also has the advantage of showing the bone's metabolic activity and is less prone to metal artifact than Magnetic resonance imaging (MRI). MRI has evolved to become an important diagnostic tool for the evaluation of THR in the post-operative period. Optimized pulse sequences and metal artifact reduction techniques have made MRI a useful tool in diagnosis of soft tissue abnormalities and is particularly useful in identifying adverse local tissue reactions in metal on metal implants. CT and MRI are accurate in identifying the diagnosis of most causes of THR complications except infection. Research confirms that leukocyte-marrow scintigraphy is the modality of choice for accurately diagnosing prosthetic joint infection and reassures us of its superiority over other nuclear medicine imaging. However, due to the limited availability and increased costs when performing leukocyte-marrow scintigraphy, CT and SPECT-CT would be a more preferred option when suspecting prosthesis infection. Ultrasound (US) has a limited role in the assessment of most THR complications but can be useful to identify peri-prosthetic fluid collections and the presence of soft tissue sinus tracts. Being aware of the imaging modalities that are available to orthopedic surgeons, and discussing these challenging cases with specialist radiologists will enable optimal management of THR complications.

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Section: Overview Of Imaging Modalitiesmentioning

confidence: 99%

Radiological Imaging Evaluation of the Failing Total Hip Replacement

Mushtaq

Gooding

et al. 2019

Front. Surg.

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“…In the appropriate clinical setting, narrowing of the ischiofemoral interval with resultant edema and fatty atrophy of quadratus femoris muscle can be indicative of this diagnosis. 6…”

Section: Muscle and Tendon Injurymentioning

confidence: 99%

“…Soft tissue complications are poorly identified on radiographs until their later stages. 5,6 Owing to new advancements and developments, particularly in magnetic resonance imaging (MRI), an earlier and more accurate imaging diagnosis of THA abnormalities is now possible. In a companion article in this issue, we review the spectrum of metal artifact reduction techniques for MRI of hip arthroplasty implants.…”

mentioning

confidence: 99%

Advanced MR Imaging after Total Hip Arthroplasty: The Clinical Impact

Khodarahmi

Fritz

2017

Semin Musculoskelet Radiol

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Recent metal artifact reduction techniques in magnetic resonance imaging (MRI) have sparked a new aera in visualization of the peri-implant region and assessment of failing orthopaedic hardware. Modes of failure after total hip arthroplasty can be classified into four broad categories: osseous abnormalities, implant instability and dislocation, implant-associated synovitis, and soft tissue abnormalities. Although MRI is complementary to plain radiography and computed tomography to diagnose the first two categories, it is paramount to investigate the complications related to the synovium and soft tissues. We review the most common modes of failure of hip implants and the MRI characteristics of various causes of pain and dysfunction after hip arthroplasty including osseous stress reaction and fracture, implant loosening, implant instability, polyethylene wear–induced synovitis, adverse reaction to metal debris, infection, hematoma, recurrent hemarthrosis, heterotopic ossification, muscle, tendon, and nerve abnormalities, and periprosthetic neoplasms.

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“…Furthermore, periprosthetic radiolucency of > 2 mm, as well as progressive radiolucency over time, were reported to be suggestive for aseptic loosening of the femoral stem (25,27).…”

Section: Introductionmentioning

confidence: 99%

Mid-term Subsidence and Periprosthetic Radiolucency of the AMIStem: A 5-year EBRA-FCA Analysis

Hasler

Flury

Dimitriou

et al. 2020

Preprint

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Background: There has been an evolution in cementless total hip arthroplasty (THA) with newer short stem designs aim to preserve metaphyseal bone stock and facilitate implantation through minimally invasive approaches. While early subsidence has been correlated to aseptic loosening in conventional stems, there is a paucity of data regarding short stems. The current study aims to report on stem subsidence and midterm clinical outcomes of a cementless, metaphyseal-anchored short femoral stem, specifically designed for the direct anterior approach (DAA).Methods: 94 consecutive patients (100 hips) with a minimum follow-up of 5 years following cementless THA were included in this single-center retrospective study. Subsidence was evaluated using the “Ein-Bild-Roentgen-Analyse” (EBRA). Periprosthetic radiolucency allocated to the Zones of Charnley and Gruen was assessed. Additionally, demographic and implant-related factors potentially associated with increased subsidence and clinical outcomes were evaluated.Results: At the last follow-up, the average stem subsidence was 1.98 ± 1.20 mm, with 48% of the implants demonstrating subsidence of > 2 mm. Periprosthetic radiolucency of > 2 mm was found in 26% of the implants in Zone 1, and in 9% in Zone 7, respectively. Neither the amount of subsidence nor proximal periprosthetic radiolucency was associated with aseptic loosening or worse clinical outcomes. Conclusions: Comparable to other proximally-fixed short stem designs, the highest subsidence was observed within the first 3 months following implantation. No demographic or implant-related factors were found to have a statistically significant influence on stem subsidence. Periprosthetic radiolucency and subsidence of the AMISstem is not correlated with worse clinical outcomes at 5-years follow-up.

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Imaging of the Painful Hip Arthroplasty

Cited by 21 publications

References 40 publications

Radiological Imaging Evaluation of the Failing Total Hip Replacement

Radiological Imaging Evaluation of the Failing Total Hip Replacement

Advanced MR Imaging after Total Hip Arthroplasty: The Clinical Impact

Mid-term Subsidence and Periprosthetic Radiolucency of the AMIStem: A 5-year EBRA-FCA Analysis

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