There is no good way to precisely quantify the amount of bone in contact with uncemented acetabular cups; consequently, the radiologist and orthopedist must estimate this amount to predict whether a cup will be loose (10). On the femoral side, fractures, bone loss at the proximal femur (ie, the calcar), and loss of the normal diaphyseal tapering are important for surgical planning. Using both modalities in a complementary way, one can systematically evaluate the prosthesis and detect numerous potential complications by asking the following questions: (a) Is the implant properly positioned and intact? Once this is established, proper imaging can be performed to better understand how to provide relief. In uncemented implants, visible areas of bone in-growth indicate solid fixation (28). The fluid collection proved to be an abscess caused by Staphylococcus aureus. Imaging of reconstructed hips can represent a significant part of the clinical workload for a typical musculoskeletal or general radiology practice. Loose components are sometimes obvious to the surgeon and radiologist, but the imaging signs of loosening can be extremely subtle. Viewer. Sagittal reformatted CT image shows a femoral stem with a few air bubbles in the cement mantle (arrows), which represent a normal finding.Figure 11Download as PowerPointOpen in Image As a general rule, the less bone that is in contact with the cup, the more likely it is that the cup is loose. The physician can properly see the hip … Comparison of Metal Artifact Reduction for Orthopedic Implants versus Standard Filtered Back Projection: Value of Postoperative CT after Hip Replacement, An exploratory study into measuring the cortical bone thickness from CT in the presence of metal implants, Periprosthetic Femoral Fractures in the Emergency Department: What the Orthopedic Surgeon Wants to Know, Imaging in peri-prosthetic assessment: an orthopaedic perspective, Bone scan usefulness in patients with painful hip or knee prosthesis: 10 situations that can cause pain, other than loosening and infection, Pelvic Beam-Hardening Artifacts in Dual-Energy CT Image Reconstructions: Occurrence and Impact on Image Quality, Imaging After Hip Joint Replacement Surgery in the Elderly Population, Metal artifact reduction (MAR) based on two-compartment physical modeling: evaluation in patients with hip implants, Metallosis in shoulder arthroplasty: an integrative review of literature, Le scanner des prothèses de hanche : techniques et indications, Évolution de l’imagerie des prothèses de hanche : algorithme diagnostique, CT of hip prosthesis: New techniques and new paradigms, Developments in imaging methods used in hip arthroplasty: A diagnostic algorithm, [124I]FIAU: Human dosimetry and infection imaging in patients with suspected prosthetic joint infection, Utilizing Autologous Multipotent Mesenchymal Stromal Cells and Axial CT showed an intact prosthesis. A radiology nurse or technologist will ask you a few questions regarding your medical history. S1, Journal de Radiologie Diagnostique et Interventionnelle, Vol. 5, Journal of Clinical Imaging Science, Vol. Component wear in a patient with a left total hip prosthesis. Finally, radiologists must be familiar with the normal and abnormal CT appearances of hip prostheses and be able to recognize common complications on CT scans. Total hip prostheses can be conventional or resurfacing types (Fig 3). Often your doctor can determine that you have a hip fracture based on your symptoms and the abnormal position of your hip and leg. Normal and abnormal radiographic findings, CT outperforms radiography for determination of acetabular cup version after THA, Computed tomography measurement of acetabular cup anteversion and retroversion in total hip arthroplasty, A new CT method for measuring cup orientation after total hip arthroplasty: a study of 10 patients, Iliopsoas impingement on the acetabular component: radiologic and computed tomography findings of a rare hip prosthesis complication in eight cases, Mechanisms of failure of total hip replacements: lessons learned from retrieval studies. 38, No. The table you are on will slide into the scanner. The normal acetabular cup has approximately 40° of lateral inclination (ie, superior tilt relative to a horizontal line, such as between the tips of the ischial tuberosities) and approximately 15° of anteversion (29). 10, 21 November 2017 | European Spine Journal, Vol. Note also the bearing surfaces in Figures 2, 3b, and 7: metal-on-cartilage (Fig 2a), metal-on-polyethylene and metal-on-cartilage (Fig 2b), metal-on-polyethylene (Fig 3b), and ceramic-on-ceramic (Fig 7). I had a hip replacement 2 years ago but have no … 97, No. Sagittal reformatted CT image shows a stress fracture (arrow) adjacent to the femoral stem. *We typically obtain two sets of coronal and sagittal reformatted images of hip implants: one set of the entire implant and a second set showing a magnified view of the cup and proximal stem. Coronal reformatted CT images of two different total hip prostheses show metal-on-metal (a) (cf Fig 3a) and ceramic-on-polyethylene (b) bearing surfaces. (a) Initial coronal reformatted CT image shows wear of the polyethylene liner and superior subluxation of the ceramic femoral head. This can help evaluate component loosening or demonstrate communication of periarticular fluid collections with the joint. 3, No. 1, 16 January 2017 | Current Radiology Reports, Vol. Laboratory tests. Radiography is the primary means of assessing implant integrity. Modern computer technology will likely bring these techniques into the mainstream of clinical practice over the next few years. Periprosthetic Soft-Tissue Masses and Fluid Collections.—CT is less useful for soft-tissue evaluation, but it may be the study of choice if a patient cannot undergo MR imaging or if periarticular ossified masses are being evaluated. Viewer. Over time, hip prostheses have become more complicated because of modular designs and the use of multiple materials. Uncemented components can be identified by the lack of a cement mantle, the presence of marrow or bone abutting the component surface, textured surfaces of in-growth components, or (if applicable) the presence of cup pegs or screws (Fig 5). It can be caused by a variety of conditions, including illness, injury, and chronic diseases like arthritis. A basic understanding of hip reconstruction and hip implants is required for proper image interpretation. However, malignant soft-tissue and bone tumors have also been reported in association with hip prostheses, although a causative relationship has not been clearly established (45,46). These components can be constructed from a metal alloy (cobalt-chrome, stainless steel, titanium, tantalum), plastic (ultra-high-molecular-weight polyethylene), or ceramic (aluminum oxide, zirconium oxide). However, ossification can be exuberant and lead to debilitating pain and loss of function in some patients, particularly if it bridges the joint. 23, No. (b) Coronal reformatted image obtained a few years later reveals loosening of the (tilted) femoral stem, which proved to be secondary to infection. Although we do not anticipate any delay in your scheduled appointment, we recommend that you bring a book, magazine, or music player to help pass any time you may have to wait. The dye may cause you to experience a warm sensation all over your body and a metal taste in your mouth. Yes … Liner wear occurs with all joint replacements, but it occurs fastest between metal or ceramic heads and polyethylene liners. Loose femoral stem in a right total hip prosthesis. High-quality CT scans require the use of a multidetector scanner with modification of technical imaging parameters to minimize artifacts. Multidetector CT is well suited for assessing periprosthetic bone, determining precise acetabular cup position, and evaluating periprosthetic fluid collections or ossified masses. Multidetector CT is an excellent supplement to radiography for the imaging evaluation of a reconstructed hip. Coronal reformatted CT images show a unipolar implant (a) and a bipolar implant (b). CT is superior to radiography in detecting, localizing, and quantifying osteolysis around the acetabulum (6–9), which is especially helpful in patients who are being considered for revision arthroplasty (10). Hip hemiprostheses. 1, 30 November 2016 | MUSCULOSKELETAL SURGERY, Vol. Furthermore, the isotropic datasets of multidetector scanners allow high-resolution images to be reformatted in any desired plane, so that three-dimensional anatomic relationships can be clearly depicted. 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