Difference between revisions of "X-ray of hip prostheses"
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− | ==Configuration== | + | |
+ | ==Quality checking== | ||
+ | *The referral or complementary information needs to specify the type of prosthesis and when it was inserted.<ref name=SOA>{{cite web|url=http://www.ortopedi.se/pics/1/5/Hoftradiologisk_undersokning.pdf|title=Hip - Radiologic evaluation of prosthetic surgery (Swedish title: HÖFT - Radiologisk undersökning vid proteskirurgi)|website=Swedish Orthopaedic Association (SOA)|author=Radiologists: Torsten Boegård, Mats Geijer, Marianne Petrén-Mallmin. Orthopedic surgeons: Lennart Sanzén, Christer Strömberg, Torbjörn Ahl}} Publication #18, 2006</ref> | ||
+ | *Images that need to be available include the first postoperative ones, as well as the most recent previous exam.<ref name=SOA/> | ||
+ | |||
+ | ==First postoperative image: Configuration== | ||
Post-operative projectional radiography ("X-ray") is routinely performed to ensure proper configuration of hip prostheses. | Post-operative projectional radiography ("X-ray") is routinely performed to ensure proper configuration of hip prostheses. | ||
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</gallery> | </gallery> | ||
− | ==Complications== | + | [[File:Hip prosthesis zones by DeLee and Charnley system, and Gruen system.jpg|thumb|250px|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.]] |
+ | |||
+ | '''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/> 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/> | ||
+ | |||
+ | ===Report=== | ||
+ | The postoperative report should include:<ref name=SOA/> | ||
+ | *Prosthesis configuration. If the report is likely to undergo double reading, the parameters need to be given in numbers even if within normal limits. | ||
+ | *Cement coverage. | ||
+ | |||
+ | ==Further follow-ups: Complications== | ||
+ | Further follow-ups after the initial postoperative image are focused on various complications. | ||
+ | |||
===Dislocation=== | ===Dislocation=== | ||
<gallery widths=200 heights=200> | <gallery widths=200 heights=200> | ||
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On radiography, it is normal to see thin radiolucent areas of less than 2 mm around hip prosthesis components, or between a cement mantle and bone. However, these may still indicate loosening of the prosthesis if they are new or changing, and areas greater than 2 mm may be harmless if they are stable.<ref name="RothMaertz2012"/> The most important prognostic factors of cemented cups are absence of radiolucent lines in DeLee and Charnley zone I, as well as adequate cement mantle thickness.<ref>{{cite book|title=The Well-Cemented Total Hip Arthroplasty: Theory and Practice|url=https://books.google.se/books?id=PQ6NZAeJUXcC&pg=PA337&lpg=PA336|author=Steffen Breusch, Henrik Malchau|publisher=Springer Science & Business Media|year=2005|isbn=978-3-540-24197-3|page=336}}</ref> In the first year after insertion of uncemented femoral stems, it is normal to have mild subsidence (less than 10 mm).<ref name="RothMaertz2012">{{cite journal|last1=Roth|first1=Trenton D.|last2=Maertz|first2=Nathan A.|last3=Parr|first3=J. Andrew|last4=Buckwalter|first4=Kenneth A.|last5=Choplin|first5=Robert H.|title=CT of the Hip Prosthesis: Appearance of Components, Fixation, and Complications|journal=RadioGraphics|volume=32|issue=4|year=2012|pages=1089–1107|issn=0271-5333|doi=10.1148/rg.324115183}}</ref> | On radiography, it is normal to see thin radiolucent areas of less than 2 mm around hip prosthesis components, or between a cement mantle and bone. However, these may still indicate loosening of the prosthesis if they are new or changing, and areas greater than 2 mm may be harmless if they are stable.<ref name="RothMaertz2012"/> The most important prognostic factors of cemented cups are absence of radiolucent lines in DeLee and Charnley zone I, as well as adequate cement mantle thickness.<ref>{{cite book|title=The Well-Cemented Total Hip Arthroplasty: Theory and Practice|url=https://books.google.se/books?id=PQ6NZAeJUXcC&pg=PA337&lpg=PA336|author=Steffen Breusch, Henrik Malchau|publisher=Springer Science & Business Media|year=2005|isbn=978-3-540-24197-3|page=336}}</ref> In the first year after insertion of uncemented femoral stems, it is normal to have mild subsidence (less than 10 mm).<ref name="RothMaertz2012">{{cite journal|last1=Roth|first1=Trenton D.|last2=Maertz|first2=Nathan A.|last3=Parr|first3=J. Andrew|last4=Buckwalter|first4=Kenneth A.|last5=Choplin|first5=Robert H.|title=CT of the Hip Prosthesis: Appearance of Components, Fixation, and Complications|journal=RadioGraphics|volume=32|issue=4|year=2012|pages=1089–1107|issn=0271-5333|doi=10.1148/rg.324115183}}</ref> | ||
− | + | ===Report=== | |
− | + | Further follow-up reports should include at least:<ref name=SOA/> | |
− | + | *Absence of change in position, or a description of any change. | |
+ | *Absence or of loosening, or a description of it. | ||
==References== | ==References== | ||
{{Reflist}} | {{Reflist}} |
Revision as of 12:12, 6 July 2018
Author:
Mikael Häggström [notes 1]
Contents
Quality checking
- The referral or complementary information needs to specify the type of prosthesis and when it was inserted.[2]
- Images that need to be available include the first postoperative ones, as well as the most recent previous exam.[2]
First postoperative image: Configuration
Post-operative projectional radiography ("X-ray") is routinely performed to ensure proper configuration of hip prostheses.
The direction of the acetabular cup influences the range of motion of the leg, and also affects the risk of dislocation.[3] For this purpose, the acetabular inclination and the acetabular anteversion are measurements of cup angulation in the coronal plane and the sagittal plane, respectively.
Acetabular anteversion.[5] 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.[5]
Acetabular anteversion is normally between 5 and 25°.[3] An anteversion below or above this range increases the risk of dislocation.[3] There is an intra-individual variability in this method because the pelvis may be tilted in various degrees in relation to the transverse plane.[3]
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.[4] The vertical center of rotation instead uses the transischial line for reference.[4] The parameter should be equal on both sides.[4]
Cement coverage is regarded as acceptable when there are no translucent zones on an anteroposterior image in at least 6 of 7 Gruen-zones.[2] 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.[2] The cup should not have translucent zones in zone 1 and 2. It is acceptable to have translucent zones in parts of zone 3.[2]
Report
The postoperative report should include:[2]
- Prosthesis configuration. If the report is likely to undergo double reading, the parameters need to be given in numbers even if within normal limits.
- Cement coverage.
Further follow-ups: Complications
Further follow-ups after the initial postoperative image are focused on various complications.
Dislocation
Fracture
Post-operative femoral fractures are graded by the Vancouver classification:
Type | Description |
---|---|
A | Fracture in the trochanteric region |
B1 | Fracture around stem or just below, with well fixed stem |
B2 | Fracture around stem or just below, with loose stem but good proximal bone |
B3 | Fracture around stem or just below, with poor quality or severely comminuted proximal bone |
C | Fracture below theprosthesis |
Loosening
On radiography, it is normal to see thin radiolucent areas of less than 2 mm around hip prosthesis components, or between a cement mantle and bone. However, these may still indicate loosening of the prosthesis if they are new or changing, and areas greater than 2 mm may be harmless if they are stable.[9] The most important prognostic factors of cemented cups are absence of radiolucent lines in DeLee and Charnley zone I, as well as adequate cement mantle thickness.[10] In the first year after insertion of uncemented femoral stems, it is normal to have mild subsidence (less than 10 mm).[9]
Report
Further follow-up reports should include at least:[2]
- Absence of change in position, or a description of any change.
- Absence or of loosening, or a description of it.
References
- ↑ Andrew Still (2002-11-02). Total Hip Replacement. University of Southern California. Retrieved on 2017-01-05.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Radiologists: Torsten Boegård, Mats Geijer, Marianne Petrén-Mallmin. Orthopedic surgeons: Lennart Sanzén, Christer Strömberg, Torbjörn Ahl. Hip - Radiologic evaluation of prosthetic surgery (Swedish title: HÖFT - Radiologisk undersökning vid proteskirurgi). Swedish Orthopaedic Association (SOA). Publication #18, 2006
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Iain Watt, Susanne Boldrik, Evert van Langelaan and Robin Smithuis. Hip - Arthroplasty -Normal and abnormal imaging findings. Radiology Assistant. Retrieved on 2017-05-21.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Vanrusselt, Jan; Vansevenant, Milan; Vanderschueren, Geert; Vanhoenacker, Filip (2015). "Postoperative radiograph of the hip arthroplasty: what the radiologist should know ". Insights into Imaging 6 (6): 591–600. doi: . ISSN 1869-4101. PMID 26487647.
- ↑ 5.0 5.1 Shin, W. C.; Lee, S. M.; Lee, K. W.; Cho, H. J.; Lee, J. S.; Suh, K. T. (2015). "The reliability and accuracy of measuring anteversion of the acetabular component on plain anteroposterior and lateral radiographs after total hip arthroplasty ". The Bone & Joint Journal 97-B (5): 611–616. doi: . ISSN 2049-4394.
- ↑ John J. Callaghan, Aaron G. Rosenberg, Harry E. Rubash (2007). The Adult Hip, Volume 1 . Lippincott Williams & Wilkins. p. 958. ISBN 978-0-7817-5092-9.
- ↑ Neumann, Daniel R.P.; Thaler, Christoph; Hitzl, Wolfgang; Huber, Monika; Hofstädter, Thomas; Dorn, Ulrich (2010). "Long-Term Results of a Contemporary Metal-on-Metal Total Hip Arthroplasty ". The Journal of Arthroplasty 25 (5): 700–708. doi: . ISSN 0883-5403.
- ↑ Daniel J. Berry, Jay Lieberman (2012). Surgery of the Hip . Elsevier Health Sciences. p. 1035. ISBN 9781455727056.
- ↑ 9.0 9.1 Roth, Trenton D.; Maertz, Nathan A.; Parr, J. Andrew; Buckwalter, Kenneth A.; Choplin, Robert H. (2012). "CT of the Hip Prosthesis: Appearance of Components, Fixation, and Complications ". RadioGraphics 32 (4): 1089–1107. doi: . ISSN 0271-5333.
- ↑ Steffen Breusch, Henrik Malchau (2005). The Well-Cemented Total Hip Arthroplasty: Theory and Practice . Springer Science & Business Media. p. 336. ISBN 978-3-540-24197-3.
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