Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging Strategy

Abstract

Hip arthroplasty (HA) is a frequently used procedure with high success rates, but 7% to 27% of the patients complain of persistent postsurgical pain 1 to 4 years post-operation. HA complications depend on the post-operative delay, the type of material used, the patient’s characteristics, and the surgical approach. Radiographs are still the first imaging modality used for routine follow-up, in asymptomatic and painful cases. CT and MRI used to suffer from metallic artifacts but are nowadays central in HA complications diagnosis, both having their advantages and drawbacks. Additionally, there is no consensus on the optimal imaging workup for HA complication diagnosis, which may have an impact on patient management. After a brief reminder about the different types of prostheses, this article reviews their normal and pathologic appearance, according to each imaging modality, keeping in mind that few abnormalities might be present, not anyone requiring treatment, depending on the clinical scenario. A diagnostic imaging workup is also discussed, to aid the therapist in his imaging studies prescription and the radiologist in their practical aspects.

Deviation of Latitude Cut: A Simple Sign to Differentiate Total Hip Arthroplasty from Hemiarthroplasty in Radiography

“…Under normal circumstances, this serves as a reliable indicator for distinguishing hemiarthroplasty from THA, as the fundamental difference lies in whether the acetabular articular surface is replaced. Nevertheless, when the acetabular cartilage is worn down to the extent that the outer cup of the hemiarthroplasty contacts or protrudes into the subchondral bone, resulting in acetabular erosion and migration, the absence of the adjacent cartilage joint space could lead readers to mistakenly interpret such cases as an acetabular cup placed in a reamed acetabulum in THA [7,8,19] (Figure 6a). Furthermore, in THA cases, instances of aseptic loosening or osteolysis at the bone-prosthesis interface may be misinterpreted as the adjacent cartilage joint space observed in hemiarthroplasty [2] (Figure 6b).…”

“…Furthermore, in THA cases, instances of aseptic loosening or osteolysis at the bone-prosthesis interface may be misinterpreted as the adjacent cartilage joint space observed in hemiarthroplasty [2] (Figure 6b). cup placed in a reamed acetabulum in THA [7,8,19] (Figure 6a). Furthermore, in THA cases, instances of aseptic loosening or osteolysis at the bone-prosthesis interface may be misinterpreted as the adjacent cartilage joint space observed in hemiarthroplasty [2] (Figure 6b).…”

“…Radiography is not only simple, less expensive, and less affected by artifacts but also provides higher image resolution and takes less time than computed tomography or magnetic resonance imaging. The initial step in recognizing complications in radiography is the determination of the type of replacement [7]. Radiologists and orthopedic surgeons can easily distinguish the two types of prostheses based on patients' previous surgical records or serial postoperative images.…”

A scoring system to evaluate stability of percutaneous osseointegrated implants for transfemoral amputation with validation in the ITAP clinical trial

“…The Engh scale, 37 directly derives interface conditions from radiographic analyses such as bony pedestals (bridging the medullary canal) or spot welds (bone formation between endosteal surface and implant) being indications of instability or stability respectively. 38 Non weight bearing POI such as dental implants measure micromotions with Resonant Frequency Analysis (RFA), denoted by an Implant Stability Quotient (ISQ), 39 which has a nonlinear correlation to micromotion. 40 Some studies estimate osseointegration using ISQ, and although consensus on clinical interpretation of data is enigmatic in the field, 41 ISQ are currently used to determine implant loading regimes and as an indicator for implant failure.…”

Polycrystalline Diamond as a Potential Material for the Hard-on-Hard Bearing of Total Hip Prosthesis: Von Mises Stress Analysis

“…However, there are several serious problems found in the use of these three materials from a clinical standpoint. For example, polymer produces polymeric wear debris, which trigger osteolysis [ 6 ]; metal can release metal ions that enter the body tissues, causing metallosis [ 7 ]; ceramic has a disadvantage of fracture failure [ 8 ].…”