Arthrography for the assessment of pain after total hip replacement. A comparison of arthrographic findings in patients with and without pain

Definition of endoprosthetic loosening: Comparison of arthrography, scintigraphy and roentgen stereophotogrammetry in prosthetic hips

“…Contrast arthrography (Murray & Rodrigo 1975, ONeill & Harris 19841, radionuclide arthrography (Abdel-Dayem et al 1982, Uri et al 1984) and provocational investigation with RSA (Mjoberg et al 198413) are to some extent complementary in the detection of instability; in our series none of these methods revealed all the unstable prosthetic components: two femoral components proved unstable by RSA and one femoral component found loose at revision had normal arthrograms ( Figure 2); fibrous tissue may prevent the arthrographic medium penetrating the interfaces (Schneider et al 1982). On the other hand, in four prosthetic components (one acetabular and three femoral) with abnormal arthrogram, an indirect sign of instability (O'Neill& Harris, 19841, and in another femoral component found loose at revision, RSA did not reveal instability (Figures 1 and 2).…”

“…THP is controversial (Murray & Rodrigo 1975, Weber & Charnley 1975, Hackel et al 1978, Weiss et al 1979, Carlsson & Gentz 1980, Dobbs 1980, Hendrix & Andersson 1981, Schneider et al 1982, O'Neill & Harris 1984. Our findings indicate that loosening should be defined as migration.…”

Loosening of the cemented hip prosthesis

“…The diagnostic criteria of loosening in conventional radiography (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), contrast and radionuclide arthrography (16,(21)(22)(23)(24), bone scintigraphy (16,(24)(25)(26)(27)(28) and roentgen stereophotogrammetry (29)(30)(31)(32)(33)(34)(35)(36)(37) are controversial, which may partly account for that the reported rates of loosening vary considerably; the reported rate of radiographic loosening varies from less than 1 per cent to 29 per cent for the acetabular component and from less than 1 per cent to 41 per cent for the femoral component (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)38). Confusion also arises because only some hips with obviously loose prosthetic components are painful (1, 4, 7-9, 39, 40).…”

Plain Film and Arthrographic Findings in Painful Total Hip Arthroplasties with Surgical Correlation

“…One patient in our study had contrast medium in the prosthesis cement and cement-bone interfaces strongly suggestive of loosening of the femoral component on arthrography, but reported solid at surgery. Other studies have reported similar cases but more usually involving the acetabular component (Brown & Knickerbocker 1973;Hankey et a1 1979;Murray & Rodrigo 1975;O'Neill & Harris 1984;Phillips & Kattapuram 1982;Tehranzadeh et a1 1981). There are a number of possible explanations for these false positives.…”