Radiological evaluation of painful total hip replacement.

Abstract

Ninety-four cases of clinically failed, cemented, total hip prostheses requiring surgery were reviewed to determine the accuracy of preoperative plain radiography, culture of aspirated fluid, arthrography, and bone scanning. When radiopaque cement had been used to embed the prosthesis, plain radiography was highly accurate in detecting a loose femoral component, less so in detecting a loose acetabular component. Culture of aspirated fluid was accurate in diagnosing infection. A positive arthrogram identified loosening with good accuracy; however, a negative arthrogram did not reliably exclude loosening. 99mTc bone scans frequently differentiated loosening from loosening with infection. The suggested sequence of diagnostic tests is plain radiography followed by bone scanning. If the bone scan shows diffuse augmented uptake, culture of aspirated fluid followed by arthrography is indicated.

NIH consensus development conference total hip joint replacement

“…Extensive pharmacologic studies of specific agents in the treatment of osteoarthritis have been camed out in a somewhat different experimental model of osteoarthritis in rabbits in which degenerative changes follow removal of a small portion of the fibular collateral and sesamoid ligaments and the anterior aspect of the lateral meniscus (9). In pilot studies utilizing this model, osteoarthritic lesions were diminished following systemic administration of low doses of glucocorticoids, pirprofen (a new nonsteroidal antiinflammatory agent), and tribenoside, a glucofuranoside derivative.…”

“…Porous polymers have been studied for orthopaedic implant A potential benefit of using lower-elastic-modulus polymeric implants is that they are less likely to lead to bone disuse atrophy because of stress protection of bone (9). The disadvantage of these polymeric systems, however, is their lower mechanical properties.…”

“…Radiologic evaluation includes at least the following modalities: conventional and magnification radiography, tomography, arteriography, arthrography, radionuclide scintigraphy, and computed tomography (CT) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”

Total Hip Replacement in Juvenile Chronic Arthritis

“…39, Table 2) deep infection was suspected. He was never painfree after the THR and the radiograms revealed progressing irregular radiolucent zones (>2 mm) between the cement and the femoral shaft (Bergstrom et al 1974, Tehranzadeh et al 1981. Erythrocyte sedimentation rate was 91 mm at 13 months when revision arthroplasty with gentamicin cement was performed with good results 31 months later.…”

Current Possibilities for Detection of Loosening of Total Hip Replacements and How Intelligent Implants Could Improve Diagnostic Accuracy

“…These data show the lowest accuracy of 76 % for femoral components (Köster et al, 1993) and 66 % for acetabular components (Ovesen et al, 2003) and demonstrate that the loosening status of the THR cannot be verified precisely (Lyons et al, 1985). In this context it is important to mention that not every author differentiates between investigating the acetabular and the femoral component (Gelman et al, 1976;Barentsz et al, 1986;Tehranzadeh et al, 1981).…”