X-ray of hip prostheses
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. For this purpose, the acetabular inclination and the acetabular anteversion are measurements of cup angulation in the coronal plane and the sagittal plane, respectively.
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. The vertical center of rotation instead uses the transischial line for reference. The parameter should be equal on both sides.
Post-operative femoral fractures are graded by the Vancouver classification:
|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|
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. 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. In the first year after insertion of uncemented femoral stems, it is normal to have mild subsidence (less than 10 mm).
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