Radiological Evaluation of the Interfaces After Cemented Total Hip Replacement

Abstract

Three radiological methods are commonly used to assess the outcome of total hip replacement (THR). They aim to record the appearance of lucent areas and migration of the prosthesis in a reproducible manner. Two of them were designed to monitor the implant through time and one to grade the quality of cementing. We have measured the level of inter-and intraobserver agreement in all three systems. We randomised 30 patients to receive either finger packing or retrograde gun cementing during Charnley hip replacements. The postoperative departmental radiographs were evaluated in a blinded study by two orthopaedic trainees, two consultants and two experts in THR. The trainees and consultants repeated the exercise at least two weeks later. We used the unweighted kappa statistic to establish the levels of agreement. In general, intraobserver agreement was moderate but interobserver agreement was poor, with levels similar to or less than those expected by chance. Our results indicate that such systems cannot provide reliable data from centres in different parts of the world, with various levels of surgeon evaluating radiographs at differing time intervals. We discuss the problem and suggest some methods of improvement.

Aggressive Early Débridement for Treatment of Acutely Infected Cemented Total Hip Arthroplasty

“…Osteolytic lesions were documented and classified on the basis of their size (linear or expansile) and their location according to previously published criteria by Zicat et al [41]. Substantial interobserver variability can be expected using these criteria [21,29].…”

Predicción de aflojamiento mecánico en cotilos cementados mediante la radiografía postoperatoria inmediata

“…13 La falla clínica y radiográfica de los cótilos cementados se puede atribuir, entre otras cosas, a la calidad del cementado inicial, la cual puede ser evaluada por radiografías obtenidas en el posoperatorio inmediato. [5][6][7]13,[15][16][17][18][19] La demarcación alrededor del cótilo expresa diferentes aspectos en la radiografía posoperatoria o en las del seguimiento. Mientras en la primera es la expresión de una incorrecta interdigitación del cemento en el hueso (por lo tanto, un cementado defectuoso), en las del seguimiento la demarcación es indicadora de micromovilidad en la interfase, con la consiguiente formación de una membrana reactiva.…”

“…13,14,18,19 Son varios los factores que influyen en el mejoramiento de la técnica de cementación. La anestesia hipotensiva cumple un papel fundamental al ejercer control sobre la hemorragia del hueso esponjoso acetabular, lo cual permite mejorar la penetración del cemento en el hueso.…”

What Are the Risks Accompanying the Reduced Wear Benefit of Low-clearance Hip Resurfacing?

“…Complete radiolucencies in all zones with or without migration was classified as loosening. The literature shows that these standardized assessments of adverse events at the implant-bone interface using plain radiography have an element of subjectivity, resulting in variable (0.3 to 0.8) intraobserver and interobserver reliability depending on observer experience [38], either with or without digital enhancement [26]. Acetabular cup inclination angle was assessed as the angle between the interteardrop line and the edge of the cup as described in a previous study [29].…”