Changes

Jump to navigation Jump to search

X-ray of hip prostheses

2,422 bytes added, 11:13, 13 September 2019
m
→‎Report: Plural
[[File:Hip prosthesis components.jpg|thumb|160px|Main components of a hip prosthesis<ref>{{cite web|url=http://illumin.usc.edu/61/total-hip-replacement/|title=Total Hip Replacement|website=University of Southern California|author=Andrew Still|date=2002-11-02|accessdate=2017-01-05}}</ref>]]
{{AuthorsTop
|author1=[[User:Mikael Häggström|Mikael Häggström]]
|author2=
}}
 For '''[[X-ray of the hipjoint]] ''' in the presence of a prosthesis, this article first deals with the first postoperative image which is more focused at prosthesis configuration, and separately describes subsequent follow-ups which are more focused at complications.
==Quality checking==
Post-operative projectional radiography ("X-ray") is routinely performed to ensure proper configuration of hip prostheses.
===Planning===Necessary projections are:*Frontal and axial image of the hip joint*Frontal image of the inferior parts of the hip bone (to include the [[ischium]] bones for measurements). ===Evaluation===Evaluate:*Prosthesis configuration*Cement coverage, where applicable*Any intraoperative fractures ====Configuration of total arthroplasty====The direction of the acetabular cup influences the range of motion of the leg, and also affects the risk of dislocation.<ref name=Watt/> For this purpose, the ''acetabular inclination'' and the ''acetabular anteversion'' are measurements of cup angulation in the [[coronal plane]] and the [[sagittal plane]], respectively.<gallery widths="330" heights="120150">File:Acetabular inclination of hip prosthesis.jpg|'''Acetabular inclination'''.<ref name=Vanrusselt2015/> This parameter is calculated on an anteroposterior radiograph as the angle between a line through the lateral and medial margins of the acetabular cup and the ''transischial line'' which is tangential to the inferior margins of the [[ischium]] bones.<ref name=Vanrusselt2015>{{cite journal|last1=Vanrusselt|first1=Jan|last2=Vansevenant|first2=Milan|last3=Vanderschueren|first3=Geert|last4=Vanhoenacker|first4=Filip|title=Postoperative radiograph of the hip arthroplasty: what the radiologist should know|journal=Insights into Imaging|volume=6|issue=6|year=2015|pages=591–600|issn=1869-4101|doi=10.1007/s13244-015-0438-5|pmid=26487647}}</ref>
File:Range of acetabular inclination.png|Acetabular inclination is normally between 30 and 50°.<ref name=Vanrusselt2015/> A larger angle increases the risk of dislocation.<ref name=Watt>{{cite web|url=http://www.radiologyassistant.nl/en/p431c8258e7ac3/hip-arthroplasty.html|title=Hip - Arthroplasty -Normal and abnormal imaging findings|author=Iain Watt, Susanne Boldrik, Evert van Langelaan and Robin Smithuis|website=Radiology Assistant|accessdate=2017-05-21}}</ref>
</gallery>
<gallery widths="330" heights="120150">File:Acetabular anteversion of hip prosthesis.jpg|'''Acetabular anteversion'''.<ref name="ShinLee2015"/> This parameter is calculated on a lateral radiograph as the angle between the [[transverse plane]] and a line going through the (anterior and posterior) margins of the acetabular cup.<ref name="ShinLee2015">{{cite journal|last1=Shin|first1=W. C.|last2=Lee|first2=S. M.|last3=Lee|first3=K. W.|last4=Cho|first4=H. J.|last5=Lee|first5=J. S.|last6=Suh|first6=K. T.|title=The reliability and accuracy of measuring anteversion of the acetabular component on plain anteroposterior and lateral radiographs after total hip arthroplasty|journal=The Bone & Joint Journal|volume=97-B|issue=5|year=2015|pages=611–616|issn=2049-4394|doi=10.1302/0301-620X.97B5.34735}}</ref>File:Range of acetabular anteversion.png|Acetabular anteversion is normally between 5 and 25°.<ref name=Watt/> An anteversion below or above this range increases the risk of dislocation.<ref name=Watt/> There is an [[intra-individual variability]] in this method because the pelvis may be tilted in various degrees in relation to the transverse plane.<ref name=Watt/>
</gallery>
<gallery widths="330" heights="120150">File:Leg length discrepancy after hip replacement.jpg|'''Leg length discrepancy''' after hip replacement is calculated as the vertical distance between the middle of the minor trochanters, using the acetabular tear drops<ref name=Vanrusselt2015/> or the transischial line<ref name=Watt/> as references for the horizontal plane. A discrepancy of up to 1&nbsp;cm is generally tolerated.<ref name=Vanrusselt2015/><ref name=Watt/>File:Center of rotation of hip prosthesis.jpg|'''Center of rotation''': The horizontal center of rotation is calculated as the distance between the acetabular teardrop and the center of the head (or caput) of the prosthesis and/or the native femoral head on the contralateral side.<ref name=Vanrusselt2015/> The vertical center of rotation instead uses the transischial line for reference.<ref name=Vanrusselt2015/> The parameter should be equal on both sides.<ref name=Vanrusselt2015/>
</gallery>
====Configuration of hemiarthroplasty====[[File:Femoral offset in hemiarthroplasty (crop).jpg|thumb|170px|Femoral offset in hemiarthroplasty.<ref name="JonesBriffa2017">{{cite journal|last1=Jones|first1=Carl|last2=Briffa|first2=Nikolai|last3=Jacob|first3=Joshua|last4=Hargrove|first4=Richard|title=The Dislocated Hip Hemiarthroplasty: Current Concepts of Etiological factors and Management|journal=The Open Orthopaedics Journal|volume=11|issue=Suppl-7, M4|year=2017|pages=1200–1212|issn=1874-3250|doi=10.2174/1874325001711011200}}</ref>.]] The main measures after hemiarthroplastyare:*'''Leg length discrepancy''' as in total arthroplasty above.*'''Femoral (neck) offset''', which is defined as the perpendicular distance between the intramedullary or longitudinal axis of the femur and the center of rotation of the native or prosthetic femoral head.<ref name="JonesBriffa2017"/> An offset of less than 33 mm is associated with hip dislocation.<ref name="NinhSethi2009">{{cite journal|last1=Ninh|first1=Christopher C.|last2=Sethi|first2=Anil|last3=Hatahet|first3=Mohammed|last4=Les|first4=Clifford|last5=Morandi|first5=Massimo|last6=Vaidya|first6=Rahul|title=Hip Dislocation After Modular Unipolar Hemiarthroplasty|journal=The Journal of Arthroplasty|volume=24|issue=5|year=2009|pages=768–774|issn=08835403|doi=10.1016/j.arth.2008.02.019}}</ref> ====Cement coverage====Cement coverage is regarded as acceptable when there are no translucent zones on an anteroposterior image in at least 6 of 7 Gruen-zones.<ref name=SOA/>  [[File:Hip prosthesis zones by DeLee and Charnley system, and Gruen system.jpg|thumb|250px|center|Hip prosthesis zones according to DeLee and Charnley,<ref>{{cite book|title=The Adult Hip, Volume 1|url=https://books.google.com/books?id=-fwULYB1gJIC&pg=PA958|author=John J. Callaghan, Aaron G. Rosenberg, Harry E. Rubash|publisher=Lippincott Williams & Wilkins|year=2007|isbn=978-0-7817-5092-9|page=958}}</ref> and Gruen.<ref>{{cite journal|last1=Neumann|first1=Daniel R.P.|last2=Thaler|first2=Christoph|last3=Hitzl|first3=Wolfgang|last4=Huber|first4=Monika|last5=Hofstädter|first5=Thomas|last6=Dorn|first6=Ulrich|title=Long-Term Results of a Contemporary Metal-on-Metal Total Hip Arthroplasty|journal=The Journal of Arthroplasty|volume=25|issue=5|year=2010|pages=700–708|issn=0883-5403|doi=10.1016/j.arth.2009.05.018}}</ref> These are used to describe the location of for example areas of loosening.]] Absence of cement in zone 7 (medially-proximally) needs to be noted. On a lateral image, the distal tip of the prosthesis should be centered, and not be in contact with the cortex.<ref name=SOA/> The cup should not have translucent zones in zone 1 and 2. It is acceptable to have translucent zones in parts of zone 3.<ref name=SOA/>
'''Cement''' coverage is regarded as acceptable when there are no translucent zones on an anteroposterior image in ====Fractures====Have at least 6 of 7 Gruen-zones.<ref name=SOA/> Absence of cement in zone 7 (medially-proximally) needs to be noted. On a lateral image, the distal tip of glance at bony contours around the prosthesis should be centered, and not be in contact with the cortexorder to detect intraoperative fractures.<ref name=SOA/gallery> The cup should not have translucent zones in zone 1 and 2. It is acceptable to have translucent zones in parts of zone 3File:Intraoperative acetabular fracture, annotated.jpg|Intraoperative acetabular fracture<ref name=SOA/gallery>
===Report===
{{Reporting}}
The postoperative report should include:<ref name=SOA/>
*Prosthesis configuration. If the report is likely to undergo double reading, the parameters need to may be given in numbers even if within normal limits.
*Cement coverage.
 
{|class="wikitable"
|+ Normal report
! Basic !! Comprehensive
|-
| (Total) hip replacement with unremarkable configuration and cement coverage
| Post-operative images of total hip replacement with unremarkable configuration:
*Acetabular inclination: ___°
*Acetabular anteversion: ___°
*The right leg is ___ longer than the left, as measured at the minor trochanters.
*Equal centers of rotation.
*Proper cement coverage.
|}
{{Public Domain examples}}
{{Reporting}}
==Further follow-ups: Complications==
===Report===
{{Reporting}}
Further follow-up reports should include at least:
*Dates of the images used for comparison
*Absence or of loosening, or a description of it.<ref name=SOA/>
==References=={{Reporting}} {{ReflistBottom}}
Administrators, Editors, Administrators
3,484

edits

Navigation menu