This pictorial review aims to provide the radiologist with simple and systematic guidelines for the radiographic evaluation of a hip prosthesis. Currently, there is a plethora of commercially available arthroplasties, making postoperative analysis not always straightforward. Knowledge of the different types of hip arthroplasty and fixating techniques is a prerequisite for correct imaging interpretation. After identification of the type of arthroplasty, meticulous and systematic analysis of the following parameters on an anteroposterior standing pelvic radiograph should be undertaken: leg length, vertical and horizontal centre of rotation, lateral acetabular inclination, and femoral stem positioning. Additional orthogonal views may be useful to evaluate acetabular anteversion. Complications can be classified in three major groups: periprosthetic lucencies, sclerosis or bone proliferation, and component failure or fracture.Teaching Points• To give an overview of the different types of currently used hip arthroplasties.• To provide a simple framework for a systematic approach to postoperative radiographs.• To discuss radiographic findings of the most common complications.
We present a case of an 80-year-old man with progressive pain for 5 days at the medial and plantar aspect of the left heel. Wearing shoes aggravated the pain. Ultrasound and magnetic resonance imaging (MRI) revealed thrombosis of the medial plantar veins. Plantar vein thrombosis is a rare condition. The clinical symptoms are non-specific and can be confused with plantar fasciitis. It has been associated with hypercoagulable conditions, foot trauma and recent surgery. The imaging modality of choice is ultrasound. MRI may add to the diagnosis in unclear cases.
A 51-year-old male presented at our department with a slightly painful soft tissue lump at the superior pole of the patella and limited range of joint motion. MRI of the left knee confirmed a soft tissue mass within the distal quadriceps extending into the superior aspect of the patella. The mass was hypointense on T1-weighted images (WI) (Fig. A, arrows) and slightly heterogeneous hyperintense on fat saturated intermediate-WI (Fig. B, arrows). A bone infarct was seen in the distal femur ( Fig. A and B, arrowhead). After administration of gadolinium contrast heterogeneous enhancement was seen. Gradient-echo sequences did not reveal blooming artifact. Additionally Cone Beam CT showed the soft tissue mass as being slightly hyperdense to the surrounding soft tissue (Fig. C, arrow). Partially sclerotic delineated osteolysis was seen at the patella (Fig. C, arrowhead).Based on the clinical presentation and imaging findings, tophaceous gout was suspected. After repeated anamnesis, the patient admitted alcohol overconsumption for many years and having previous gout attacks at the feet. Because of the aggressive nature of the process, a biopsy was performed in order to exclude a malignant tumor. The biopsy specimen showed the presence of monosodium urate (MSU) crystals, in keeping with tophaceous gout. The patient was reassured, was provided with appropriate dietary advice and nonsteroidal anti-inflammatory drugs. CommentGout is a metabolic disorder resulting in hyperuricemia. It is a very common condition with a peak incidence at the fifth decade of life. Men are more affected than women. Clinical manifestations of gout are asymmetric arthritis and/or soft tissue nodules. The most affected site is the first metatarsophalangeal joint, followed by the first interphalangeal joint. The hand and wrist are also commonly affected. The patella is an unusual site of gout. Clinical presentation and laboratory values are usually sufficient IMAGES IN CLINICAL RADIOLOGY
A 27-year-old male and indoor soccer goalkeeper presented at the private practice of the orthopaedic surgeon with pain in the posterior right shoulder. Two months previously, he felt sudden pain and loss of function in his shoulder when throwing a ball, more specifically during ball release. After 6 weeks of rest, there was almost complete recovery. He started playing indoor soccer again and fell on his right shoulder with relapse of the pain. He never experienced dislocation of the shoulder. Clinically there was full range of motion of his shoulder and no muscle atrophy. Resistance tests of the triceps brachii muscle caused pain in the posterior shoulder.A plain film of the right shoulder showed a bony fragment at the inferior rim of the glenoid (Fig. A, arrow). A CT-arthrography (Fig. B, C) and MR-arthrography showed a sclerotic delineated avulsion fragment at the infraglenoid tubercle, but showed no concomitant lesion of the antero-inferior labrum (Fig. B, arrow). There was no Hill-Sachs lesion and the rotator cuff was normal. There was no tendon retraction of the long head of the triceps brachii muscle (Fig. C, arrow).Based on the clinical presentation and imaging findings, the diagnosis of a proximal avulsion fracture of the long head of the triceps brachii muscle was made. The patient was treated conservatively with relative rest and nonsteroidal analgetics. After 3 months of follow-up, the patient was pain-free during his daily activities and could restart his indoor soccer training with throwing-exercises. CommentThe triceps brachii muscle consists of three muscular heads: a lateral head with its origin on the latero-posterior side of the humeral diaphysis, a medial head originating from the medio-posterior side of the humeral diaphysis and superficial of these two heads the long head with its origin on the infraglenoid tubercle. These three heads join at the distal triceps tendon inserting on the olecranon. The function of the triceps brachii muscle is extension of the elbow and adduction of the arm by the long head.A traumatic tear or avulsion fracture of the triceps tendon is uncommon, accounting for less than 1% of all tendon injuries. Most triceps tendon injuries are located at the distal insertion of the tendon into the olecranon. Proximal triceps tendon injuries are even rarer.The probable trauma mechanism in our case consists of a bony avulsion that occurred when throwing a ball, more specifically at the end of the extension of the elbow.In case of proximal triceps tendon injury, plain films may show an avulsion fragment at the infraglenoid tubercle, which may be confirmed on Computed Tomography (CT) or CT-arthrography. MR-arthrography is less suited for demonstrating osseous avulsions without labrum lesions. The differential diagnosis includes a bony Bankart lesion and a Bennet's lesion. A bony Bankart lesion occurs during an antero-inferior shoulder dislocation and is associated with a lesion of the antero-inferior labrum. A Bennet's lesion is a calcium deposition in the posterior capsule of th...
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