Developments in imaging methods used in hip arthroplasty: A diagnostic algorithm

Blum, Alain; Gondim-Teixeira, P.; Gabiache, Erwan; Roche, Olivier; Sirveaux, François; Olivier, Pierre; Coudane, H.; Raymond, A.; Louis, M.; Grandhaye, Marion; Meyer, J.-B.; Mainard, Didier; Molé, Daniel

doi:10.1016/j.diii.2016.07.001

Cited by 28 publications

(15 citation statements)

References 77 publications

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“…In this case, quantitative CT-based measurements would be helpful. Metal artifacts reduce the diagnostic value of CT’s [8]. Such artifacts can result in damage of the informative value while assessing implant stability.…”

Section: Discussionmentioning

confidence: 99%

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Computed tomography for managing periprosthetic femoral fractures. A retrospective analysis

Rupp

Kern

Ismat

et al. 2019

BMC Musculoskelet Disord

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Background Periprosthetic fractures (PPF) present a common cause for revision surgery after arthroplasty. The choice of performing either an osteosynthesis or revision arthroplasty depends on the orthopedic implant anchored and loosening. Standard diagnostics include x-ray imaging. CT is usually performed to confirm implant loosening in case of ambiguous diagnosis on standard x-ray imaging. This study aimed to examine the role of CT as a diagnostic modality and its implications for treatment planning and outcome. Methods Patients treated for PPF from January 2010 to February 2018 were included. X-ray and CT reports were analyzed to assess implant loosening. The planning for surgery and the final surgical treatment were evaluated. In addition, patient characteristics were analyzed and compared between patients with and without additional CT as a preoperative diagnostic procedure. Results Seventy-five patients were eligible for the study. X-ray imaging was performed in 90.7% of cases. CT was performed in 60% of the cases as part of the preoperative diagnostic. A clear statement on implant stability or loosening could not be made in 69.1% after X-ray imaging and in 84.4% following CT imaging. Revision arthroplasty for loosened femoral prosthesis components was necessary in 40% of cases. No difference could be determined comparing patients with X-ray imaging to those with X-ray and additional CT. In both groups, operative treatment did not deviate from the preoperative planning. Discussion In two thirds of the conventional radiographic findings, no reliable evaluation of implant loosening was possible in femoral PPFs. Intriguingly, additional CT did not improve the evaluation of implant loosening. Nonetheless, CT scans are often performed if loosening assessment is unclear on regular radiographs. This fact can explain the bias CT results in comparison to regular radiography. However, software-supported CT diagnosis could help to adequately answer the question of loosened implants in PPF in the near future. Since the diagnosis of fracture and their morphology assessment is currently adequately performed using X-rays, CT shall not be considered as the gold standard.

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Section: Discussionmentioning

confidence: 99%

“…Conventionally, x-rays are the first-line imaging tests. A CT scan is recommended as a further diagnostic modality to assess fracture morphology, implant stability and bone stock [8]. The CT provides detailed images of cortical and trabecular bone.…”

Section: Introductionmentioning

confidence: 99%

Computed tomography for managing periprosthetic femoral fractures. A retrospective analysis

Rupp

Kern

Ismat

et al. 2019

BMC Musculoskelet Disord

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“…A plain radiograph or X-ray should be the initial imaging to be performed for any patient with a THR (7). Immediate post-operative radiographs taken whilst the patient is in recovery are ineffective for screening and unsuitable as a baseline for future evaluations (8).…”

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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“…2 Prosthesis-related complications and modes of failure are diverse and depend on myriad factors including the type of implant, surgical approach, and patient's age and general health, among others. [3][4][5] Owing to recent advancements in diagnostic modalities, particularly magnetic resonance imaging (MRI), an earlier and more accurate diagnosis of the complications has become possible.…”

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confidence: 99%

Leaps in Technology: Advanced MR Imaging after Total Hip Arthroplasty

Khodarahmi

Nittka

Fritz

2017

Semin Musculoskelet Radiol

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The vast majority of the metal-related artifacts in magnetic resonance imaging (MRI) arise from B0 inhomogeneity. These artifacts include failed fat suppression, signal loss, signal pileup, and image distortions. Metal artifact reduction sequence MRI has been used to mitigate these artifacts via optimization of the scan parameters and exploiting new techniques such as fully phase-encoded imaging and multispectral imaging including multi-acquisition variable-resonance image combination and slice encoding for metal artifact correction. Applicability of MRI in the vicinity of metal implants has been revolutionized by these new techniques at the expense of longer acquisition times. To reach clinically viable scan times, these novel techniques have been successfully coupled with various acceleration paradigms such as parallel imaging and compressed sensing.

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Developments in imaging methods used in hip arthroplasty: A diagnostic algorithm

Abstract: We have developed a diagnostic tree based on the characteristics of each imaging technique and recommend its use. Computed topography was found to be the most versatile and cost-effective imaging solution and therefore a key tool for diagnosing the complications of hip replacement surgery.

Cited by 28 publications

References 77 publications

Computed tomography for managing periprosthetic femoral fractures. A retrospective analysis

Computed tomography for managing periprosthetic femoral fractures. A retrospective analysis

Radiological Imaging Evaluation of the Failing Total Hip Replacement

Leaps in Technology: Advanced MR Imaging after Total Hip Arthroplasty

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