| 1. Charnley J. Arthroplasty of the hip. A new operation. Lancet 1961;1:1129-32. |
Review/Other-Dx |
NA |
No abstract available. |
No abstract available. |
4 |
| 2. Sloan M, Premkumar A, Sheth NP. Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018;100:1455-60. |
Review/Other-Dx |
NA |
To report the projected volume of primary total joint arthroplasty |
On the basis of 2000-to-2014 data, primary total hip arthroplasty (THA) is projected to grow 71%, to 635,000 procedures, by 2030 and primary total knee arthroplasty (TKA) is projected to grow 85%, to 1.26 million procedures, by 2030. However, TKA procedure growth rate has been slowing over recent years, and models based on 2008-to-2014 data projected growth to only approximately 935,000 procedures by 2030. |
4 |
| 3. Hu CY, Yoon TR. Recent updates for biomaterials used in total hip arthroplasty. Biomater Res 2018;22:33. |
Review/Other-Dx |
N/A |
To provide an update on the development status of various materials in THA. |
No results stated in abstract. |
4 |
| 4. Merola M, Affatato S. Materials for Hip Prostheses: A Review of Wear and Loading Considerations. Materials (Basel) 2019;12. |
Review/Other-Dx |
N/A |
To review the current state of the art of the biomaterials used for hip implants. |
No results stated in abstract. |
4 |
| 5. Rochcongar G, Remazeilles M, Bourroux E, et al. Reduced wear in vitamin E-infused highly cross-linked polyethylene cups: 5-year results of a randomized controlled trial. Acta Orthop 2021;92:151-55. |
Observational-Dx |
40 patients |
To know whether HXLPE/VitE acetabular cups continue to show less PE wear than ultra-high molecular weight polyethylene (UHMWPE) acetabular cups at 5 years. The secondary objective is to evaluate the correlation between PE wear rates with cup inclination angles or cup sizes, in addition to reporting clinical outcomes. |
HXLPE/VitE cups continued to show less cumulative femoral head penetration than UHMWPE cups (HXLPE/VitE: 0.24?mm, UHMWPE: 0.45?mm; p < 0.001). Distribution of wear was also more even with HXLPE/VitE cups than with UHMWPE cups (p = 0.002). Moreover, the difference in PE wear between 1 and 5 years in both groups showed no statistically significant correlation with increasing cup inclination angles or cup sizes. Finally, no osteolysis and implant loosening occurred, and no revision surgeries were required. |
2 |
| 6. Chang EY, McAnally JL, Van Horne JR, et al. Metal-on-metal total hip arthroplasty: do symptoms correlate with MR imaging findings? Radiology. 2012;265:848-57. |
Review/Other-Dx |
192 hips (174 patients) |
To determine the prevalence of MRI abnormalities after MoM THA and to determine whether presence of symptoms correlates with findings at MRI. |
Prevalence of pseudotumors per patient and per hip was 69% (120/174 patients, 132/192 hips). Bone marrow edema (present in 6 asymptomatic patients and 19 patients with pain, P<.01) and tendon tearing (present in 5 asymptomatic patients and 13 patients with pain, P<.05) were predictors of pain. Presence of symptoms was not correlated with presence (P=.4151) or size of pseudotumors. Anderson MR grade binarized into normal vs abnormal showed moderate agreement between readers (kappa = 0.439) but was also not correlated with symptoms (P=.6648). |
4 |
| 7. Yanny S, Cahir JG, Barker T, et al. MRI of aseptic lymphocytic vasculitis-associated lesions in metal-on-metal hip replacements. J Bone Joint Surg Am. 2012;198:1394-402. |
Review/Other-Dx |
N/A |
To describe the clinical, histopathologic, and MRI features of aseptic lymphocytic vasculitis-associated lesions in total hip replacements. |
The introduction of modern MoM hip arthroplasty has been accompanied by a newly described disease, aseptic lymphocytic vasculitis-associated lesions, which is characterized histologically by bland necrosis and dense perivascular lymphocytic infiltrates. Conventional radiographic findings are often normal, but the typical MRI findings include periprosthetic fluid collections, soft-tissue masses, gluteal tendon avulsion, bone loss, periosteal stripping, neurovascular involvement, and periprosthetic fractures. |
4 |
| 8. Madanat R, Hussey DK, Donahue GS, et al. Early Lessons From a Worldwide, Multicenter, Followup Study of the Recalled Articular Surface Replacement Hip System. Clin Orthop. 474(1):166-74, 2016 Jan. |
Observational-Dx |
288 patients |
To ask: (1) Is ALTR location related to the surgical approach used for arthroplasty in patients who underwent hip arthroplasty (resurfacing or THA) with a single, recalled hip arthroplasty system? (2) Do ALTR severity and location affect patient-reported outcomes in these patients? (3) Is ALTR severity different between patients who received the resurfacing version of this component (Articular Surface Replacement [ASR]) and those who received the THA implant in this system (ASR XL)? |
Moderate or severe ALTRs were identified in 79 hips (24%); 41 of these hips had been operated on using the direct lateral approach and 38 using the posterior approach. In patients in whom the lateral approach was used, 83% had an anterior ALTR. Similarly, 71% of patients in the posterior approach group had posterior ALTRs. There were no differences in patient-reported outcome measures between patients with moderate-to-severe ALTRs and those with no ALTR findings on MRI (p > 0.09). Use of ASR XL was an independent risk factor for moderate-to-severe ALTRs (odds ratio, 2.8; 95% confidence interval, 1.4-5.5 p = 0.004) and patients with ASR XL also had a thicker synovium (median ASR XL = 3.6 mm [1.2-10.6 mm], median ASR = 2.6 mm [1.2-10.7 mm], p < 0.001) and larger maximal ALTR diameter (median ASR XL = 47.6 mm [14-109.70 mm], median ASR = 38.4 [17.2-118.0 mm], p = 0.02) than patients treated with ASR. |
3 |
| 9. Nawabi DH, Gold S, Lyman S, Fields K, Padgett DE, Potter HG. MRI predicts ALVAL and tissue damage in metal-on-metal hip arthroplasty. Clinical Orthopaedics & Related Research. 472(2):471-81, 2014 Feb.Clin Orthop. 472(2):471-81, 2014 Feb. |
Observational-Dx |
68 patients |
To identify which MRI characteristics correlated with histologically confirmed adverse local tissue reactions (using the aseptic lymphocytic vasculitis-associated lesions score) and intraoperative tissue damage and develop a predictive model using modified MRI to detect aseptic lymphocytic vasculitis-associated lesions and quantify intraoperative tissue damage. |
Maximal synovial thicknesses and synovial volumes as determined on MRI correlated with the aseptic lymphocytic vasculitis-associated lesions score and were higher in cases of severe intraoperative tissue damage. Our MRI predictive model showed sensitivity and specificity of 94% and 87%, respectively, for detecting aseptic lymphocytic vasculitis-associated lesions and 90% and 86%, respectively, for quantifying intraoperative tissue damage. |
3 |
| 10. Bolognesi MP, Ledford CK. Metal-on-Metal Total Hip Arthroplasty: Patient Evaluation and Treatment. [Review]. J Am Acad Orthop Surg. 23(12):724-31, 2015 Dec. |
Review/Other-Tx |
N/A |
To discuss the evaluation and treatment of patients who undergo total hip arthroplasty with MoM implants. |
No results stated in abstract. |
4 |
| 11. Langton DJ, Jameson SS, Joyce TJ, Hallab NJ, Natu S, Nargol AV. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: A consequence of excess wear. J Bone Joint Surg Br 2010;92:38-46. |
Observational-Dx |
17 patients |
To establish the rate of failure secondary to adverse reactions to metal debris (ARMD) in our patients, to identify relationships between this mode of failure and the wear rate of the prosthetic joint, and to provide a potential explanation for the increased incidence of this in women. |
This group had significantly smaller components, significantly higher acetabular component anteversion, and significantly higher whole concentrations of blood and joint chromium and cobalt ions than asymptomatic patients did (all p < 0.001). Post-revision lymphocyte transformation tests on this group showed no reactivity to chromium or cobalt ions. Explants from these revisions had greater surface wear than retrievals for uncomplicated fractures. The absence of adverse reactions to metal debris in patients with well-positioned implants usually implies high component wear. |
4 |
| 12. Lohmann CH, Singh G, Willert HG, Buchhorn GH. Metallic debris from metal-on-metal total hip arthroplasty regulates periprosthetic tissues. World J Orthop 2014;5:660-6. |
Review/Other-Dx |
N/A |
To present a review of the concepts introduced by Willert and Semlitsch in 1977, along with further developments made in the understanding of periprosthetic tissue reactions to metallic debris. |
No results stated in abstract. |
4 |
| 13. McGrory BJ, Jacobs JJ, Kwon YM, Fillingham Y. Standardizing terms for tribocorrosion-associated adverse local tissue reaction in total hip arthroplasty. Arthroplast Today 2020;6:196-200. |
Review/Other-Tx |
N/A |
To develop terms that can be broadly applied to characterize the local tissue response to tribocorrosion debris, based on current evidence regarding the etiology of this failure mode and its consequences. |
No results stated in abstract. |
4 |
| 14. Chang JD, Lee SS, Hur M, Seo EM, Chung YK, Lee CJ. Revision total hip arthroplasty in hip joints with metallosis: a single-center experience with 31 cases. J Arthroplasty 2005;20:568-73. |
Observational-Dx |
31 patients |
To discuss the underlying mechanisms, causative factors, clinical or radiographic findings, or the surgical approaches used in hips with metallosis. |
Causes of metallosis were dissociation of polyethylene liner in 24 hips, catastrophic wear in 6, and the screw used for stem fixation in 1. Metallosis was grade I in 12 hips, grade II in 7, and grade III in 12. Osteolysis around the acetabular cup was observed in 24 (77.4%) of 31 hips. |
3 |
| 15. American Joint Replacement Registry (AJRR): 2021 Annual Report. Rosemont, IL: American Academy of Orthopaedic Surgeons (AAOS). Available at: https://www.aaos.org/registries/publications/ajrr-annual-report/. |
Review/Other-Tx |
N/A |
To provide a comprehensive picture of patterns of hip and knee arthroplasty practice and outcomes in the United States. |
No results stated in the abstract. |
4 |
| 16. Gwam CU, Mistry JB, Mohamed NS, et al. Current Epidemiology of Revision Total Hip Arthroplasty in the United States: National Inpatient Sample 2009 to 2013. J Arthroplasty 2017;32:2088-92. |
Review/Other-Dx |
258,461 revision THAs |
To report: (1) etiologies for revision THA; (2) frequencies of revision THA procedures; (3) patient demographics, payor type, and US Census region of revision THA patients; and (4) the length of stay and total costs based on the type of revision THA procedure. |
Dislocation was the main indication for revision THA (17.3%), followed by mechanical loosening (16.8%). All-component revision was the most common procedure performed (41.8%). Patients were most commonly white (77.4%), aged 75 years and older (31.6%), and resided in the South US Census region (37.0%). The average length of stay for all procedures was 5.29 days. The mean total charge for revision THA procedures was $77,851.24. |
4 |
| 17. Healy WL, Iorio R, Clair AJ, Pellegrini VD, Della Valle CJ, Berend KR. Complications of Total Hip Arthroplasty: Standardized List, Definitions, and Stratification Developed by The Hip Society. Clin Orthop Relat Res 2016;474:357-64. |
Review/Other-Dx |
105 survey responders |
To develop a standardized list of complications and adverse events associated with THA, develop standardized definitions for each complication, and stratify the complications. A further purpose was to validate these standardized THA complications |
One hundred five clinical members (100%) of The Hip Society responded to the THA complications survey. Initially, 21 THA complications were proposed. The validation process reduced the 21 proposed complications to 19 THA complications with definitions and stratification that were endorsed by The Hip Society (bleeding, wound complication, thromboembolic disease, neural deficit, vascular injury, dislocation/instability, periprosthetic fracture, abductor muscle disruption, deep periprosthetic joint infection, heterotopic ossification, bearing surface wear, osteolysis, implant loosening, cup-liner dissociation, implant fracture, reoperation, revision, readmission, death). |
4 |
| 18. Fritz J, Lurie B, Miller TT. Imaging of hip arthroplasty. Semin Musculoskelet Radiol. 2013;17(3):316-327. |
Review/Other-Dx |
N/A |
To discuss and illustrate the imaging appearances of conditions associated with painful or dysfunctional hip arthroplasty with a focus on the MRI evaluation. |
No results stated in abstract. |
4 |
| 19. Fritz J, Lurie B, Miller TT, Potter HG. MR imaging of hip arthroplasty implants. Radiographics 2014;34:E106-32. |
Review/Other-Dx |
N/A |
To present strategies for MR imaging of hip arthroplasty implants. |
No results stated in abstract. |
4 |
| 20. Khodarahmi I, Nittka M, Fritz J. Leaps in Technology: Advanced MR Imaging after Total Hip Arthroplasty. [Review]. Semin Musculoskelet Radiol. 21(5):604-615, 2017 Nov. |
Review/Other-Dx |
N/A |
To discuss the nature of the artifacts associated with MRI near metallic implants and offer a concise review of the traditional and new techniques of metal artifact reduction. |
No results stated in abstract. |
4 |
| 21. Koff MF, Burge AJ, Potter HG. Clinical magnetic resonance imaging of arthroplasty at 1.5 T. J Orthop Res 2020;38:1455-64. |
Review/Other-Dx |
na |
To review article will provide background information regarding the presence of image artifacts, methods to reduce the artifacts, and application of MRI at 1.5T for evaluating common complications in subjects with total knee arthroplasty, total hip arthroplasty and total shoulder arthroplasty. |
No results stated in abstract. |
4 |
| 22. Roth TD, Maertz NA, Parr JA, Buckwalter KA, Choplin RH. CT of the hip prosthesis: appearance of components, fixation, and complications. Radiographics. 2012;32:1089-1107. |
Review/Other-Dx |
N/A |
Review appearance of components, fixation, and complications of CT of the hip prosthesis. |
No results stated in abstract. |
4 |
| 23. Blum A, Meyer JB, Raymond A, et al. CT of hip prosthesis: New techniques and new paradigms. Diagn Interv Imaging. 97(7-8):725-33, 2016 Jul-Aug. |
Review/Other-Dx |
N/A |
To describe the different CT techniques used for this kind of investigation and provide indications for each technique. |
No results stated in abstract. |
4 |
| 24. Hacking C, Weinrauch P, Whitehouse SL, Crawford RW, Donnelly WJ. Is there a need for routine follow-up after primary total hip arthroplasty? ANZ J Surg. 2010;80:737-40. |
Review/Other-Dx |
158 patients |
To determine if there is the need for routine follow-up after primary THA. |
110 THAs in 104 patients (average age 70.4 (SD 9.8 years)). There were 70 (63.6%) in total, 13 (11.8%) femoral and 27 (24.5%) acetabular revisions. The indications for revision were aseptic loosening (70%), dislocation (8.2%), peri-prosthetic fracture (7.3%), osteolysis (6.4%) and infection (4.5%). Only 4 (3.6%) were asymptomatic revisions. A mean of 5.3 (SD 5.2 and 1.9 (SD 5.3)) follow-up appointments were required before revision in patients with and without symptoms, respectively. The average time from the primary to revision surgery was 11.8 (SD 7.23) years. |
4 |
| 25. Oswald SG, Van Nostrand D, Savory CG, Anderson JH, Callaghan JJ. The acetabulum: a prospective study of three-phase bone and indium white blood cell scintigraphy following porous-coated hip arthroplasty. J Nucl Med 1990;31:274-80. |
Observational-Dx |
21 patients |
To describe the scintigraphic findings related to the acetabulumin 25 prostheseso studied. |
All 25 prostheses (144 of 144 scans) demonstrated increased uptake on the bone-phase images. Although this activity decreased with time, 76% had persistent uptake at 24 mo. Twenty-three of 25 prostheses (126 of 140 scans) showed increased uptake on 111In-WBC scintigraphy, invariably decreasing with time, but with 37% having significant uptake at 24 mo. |
3 |
| 26. Oswald SG, Van Nostrand D, Savory CG, Callaghan JJ. Three-phase bone scan and indium white blood cell scintigraphy following porous coated hip arthroplasty: a prospective study of the prosthetic tip. J Nucl Med. 1989;30:1321-31. |
Review/Other-Dx |
25 uncomplicated porous coated hip arthroplasties in 21 patients |
Patients were prospectively studied using TPBS and In-111-labeled WBC scintigraphy to establish the natural history of scintigraphic changes following uncomplicated porous coated hip arthroplasty. |
Only 1 of 136 flow studies were abnormal and only 2 of 136 blood-pool images demonstrated focally increased activity. All 25 prostheses (120/143 scans) demonstrated increased uptake on the bone phase images. The area about the tip was divided into 3 segments; increased uptake at 24 months was noted in the medial, distal, and lateral segments in 16%, 72%, and 56% of prostheses, respectively. 20/25 prostheses (82/142 scans) showed uptake on In-111-WBC scintigraphy, being noted in 48% of prostheses at 24 months. |
4 |
| 27. Utz JA, Lull RJ, Galvin EG. Asymptomatic total hip prosthesis: natural history determined using Tc-99m MDP bone scans. Radiology. 1986;161:509-12. |
Review/Other-Dx |
97 patients |
To determine the normal postoperative appearance of radionuclide scans of the hip following administration of Tc-99m MDP. |
Results showed that 6 months after implantation activity around the lesser trochanter and prosthesis shaft became insignificant. Activity around the acetabulum, greater trochanter, and prosthesis tip stabilized approximately 2 years after surgery; approximately 10% of patients in the study had persistent activity in these areas. Familiarity with this normal progression is fundamental to interpretation of postoperative bone scans in patients with total hip prosthesis. |
4 |
| 28. Tam HH, Bhaludin B, Rahman F, Weller A, Ejindu V, Parthipun A. SPECT-CT in total hip arthroplasty. Clin Radiol 2014;69:82-95. |
Review/Other-Dx |
na |
To review SPECT-CT in total hip arthroplasty |
No results listed in abstract. |
4 |
| 29. Ullmark G, Nilsson O, Maripuu E, Sorensen J. Analysis of bone mineralization on uncemented femoral stems by [18F]-fluoride-PET: a randomized clinical study of 16 hips in 8 patients. Acta Orthop. 2013;84(2):138-144. |
Experimental-Dx |
16 hips in 8 patients; 12 controls |
Randomized study using F-18 fluoride PET/CT analysis for detection of bone mineralization adjacent to 2 different brands of hip prosthesis (SL-PLUS and BetaCone stems). |
The clinical results were good at 2 years. By radiography, all stems were stable. At PET analyses 1 week after surgery, the activity was higher for the SL-PLUS group than for the BetaCone group. The activity was statistically significantly higher for both stems than the reference values at 4 months, and was most pronounced in the upper femur. At 1 year, the activity had declined more for the BetaCone group than for the SL-PLUS group. |
1 |
| 30. Ullmark G, Sorensen J, Nilsson O. Analysis of bone formation on porous and calcium phosphate-coated acetabular cups: a randomised clinical [18F]fluoride PET study. Hip Int. 2012;22(2):172-178. |
Experimental-Dx |
16 THAs (8 patients) 13 controls |
To analyze bone formation on porous and calcium phosphate-coated acetabular cups using F-18 fluoride PET/CT. |
Bone forming activity had a mean of 5.71, 4.69 and 3.47 SUV around the calcium phosphate coated and 5.04, 4.80 and 3.50 SUV around the porous-coated-cups at 1 week, 4 months and 12 months, respectively. Normal bone metabolism was 3.68 SUV. After 1 year activity had declined to normal levels for both groups. The clinical results were good in all cases. Calcium phosphate coating resulted in higher uptake indicating higher bone forming activity after 1 week. F-18 fluoride PET/CT is a valuable tool to analyze bone formation and secondary stabilization of an acetabular cup. |
1 |
| 31. Cooper HJ, Ranawat AS, Potter HG, Foo LF, Koob TW, Ranawat CS. Early reactive synovitis and osteolysis after total hip arthroplasty. Clin Orthop Relat Res. 2010;468:3278-85. |
Review/Other-Dx |
31 patients (33 hips) |
To determine the incidence of early reactive synovitis and osteolysis in asymptomatic patients after THA, and whether there is an association between these MRI findings and clinical outcomes or radiographic wear measurements at this early stage. |
Reactive synovitis was observed in 13 of 33 patients (39%) and focal osteolysis in 1 of 33 (3%). The presence of synovitis did not correlate with pain, activity level, patient satisfaction or clinical outcome scales, nor did it correlate with radiographic wear measurements at early follow-up. |
4 |
| 32. Filli L, Jungmann PM, Zingg PO, et al. MRI with state-of-the-art metal artifact reduction after total hip arthroplasty: periprosthetic findings in asymptomatic and symptomatic patients. Eur Radiol. 30(4):2241-2252, 2020 Apr. |
Observational-Dx |
31 patients |
To evaluate the frequency of different periprosthetic MRI findings in asymptomatic and symptomatic patients following primary THA by applying a state-of-the art imaging protocol including CS-SEMAC. |
The asymptomatic and symptomatic groups showed different patterns of imaging findings. Bone marrow edema was seen in 19/31 (61.3%) asymptomatic and 22/27 (81.5%) symptomatic patients, most commonly in Gruen zones 1, 7, and 8 (p = 0.18). Osteolysis occurred in 14/31 (45.2%) asymptomatic and 14/27 (51.9%) symptomatic patients and was significantly more common in Gruen zone 7 in the symptomatic group (8/27 (29.6%)) compared to the asymptomatic group (2/31 (6.5%)) (p = 0.03). Periosteal reaction was present in 4/31 asymptomatic (12.9%) and 9/27 symptomatic patients (33.3%) and more common in Gruen zones 5 and 6 in the symptomatic group (p = 0.04 and 0.02, respectively). In the acetabulum, bone marrow edema pattern was encountered in 3/27 (11.1%) symptomatic patients but not in asymptomatic patients (p = 0.21). Patient management was altered in 8/27 (29.6%) patients based on MRI findings. |
2 |
| 33. Koff MF, Gao MA, Neri JP, et al. Adverse Local Tissue Reactions are Common in Asymptomatic Individuals After Hip Resurfacing Arthroplasty: Interim Report from a Prospective Longitudinal Study. Clin Orthop Relat Res 2021;479:2633-50. |
Observational-Tx |
243 patients |
To determine (1) the longitudinal changes and differences in blood metal ion levels in patients with hip resurfacing arthroplasty (HRA), ceramic-on-ceramic (CoC) THA, and metal-on-polyethylene (MoP) THA compared with those undergoing ceramic-on-polyethylene (CoP) THA; (2) how the longitudinal change of synovial reaction classification in patients with HRA, CoC THA, and MoP THA compares with those undergoing CoP THA, and whether there is an association between the presence of an ALTR or metallosis on MRI with corresponding patient-reported outcomes, or the presence of capsular dehiscence; and (3) differences in blood metal ion levels between patients undergoing HRA with an ALTR or metallosis on MRI and those with HRA without these conditions. |
Patients with unilateral HRA had higher cobalt and chromium serum ion levels (baseline: 1.8 ± 0.8 ppb, year 1: 2.0 ± 1.5 ppb, year 2: 2.1 ± 1.2 ppb, year 3: 1.6 ± 0.7 ppb) than those with unilateral CoP bearings (baseline: 0.0 ± 0.1 ppb, year 1: 0.1 ± 0.3 ppb, year 2: 0.0 ± 0.2 ppb, year 3: 0.0 ± 0.0 ppb) at all timepoints (p < 0.001 for each time point). More patients who received an HRA developed ALTR or metallosis on MRI than did patients with CoP bearings (hazard ratio 4.8 [95% confidence interval 1.2 to 18.4]; p = 0.02). There was no association between the longitudinal change of synovial reaction to ALTR or metallosis on MRI with patient-reported outcomes. In addition, there was no association between the presence of dehiscence at baseline and the subsequent development of ALTR or metallosis, as seen on MRI. There were elevated cobalt (4.7 ± 3.5 ppb) and chromium (4.7 ± 2.6 ppb) serum levels in patients with unilateral HRA who had an ALTR or metallosis present on MRI at year 1 compared with patients without an ALTR or metallosis on MRI (cobalt: 1.8 ± 1.0 ppb, mean difference 4.7 ppb [95% CI 3.3 to 6.0]; p < 0.001; chromium: 2.3 ± 0.5 ppb, mean difference 3.6 ppb [95% CI 2.2 to 5.0]; p < 0.001) as well as for chromium at year 3 (3.9 ± 2.4 ppb versus 2.2 ± 1.1 ppb, mean difference 1.3 ppb [95% CI 0.3 to 2.4]; p = 0.01). |
1 |
| 34. Bozza N, Guindani N, Pezzotta G, Alberto F, Castelli CC. 15-year follow-up of MoM 36-mm THA: clinical, laboratory, and radiological (CT and MRI) prospective assessment. Hip int.. 30(2_suppl):42-51, 2020 Dec. |
Review/Other-Dx |
46 patients |
To investigate the clinical outcomes, describe radiological findings including CT metal artefact reduction algorithm for orthopaedic implants (O-MAR) and MRI multi acquisition variable resonance image combination (MAVRIC) in 36-mm MoM THA. |
At 15 years, the overall survival rate of the implants (both stems and cups) was 83% (30/36). Revisions were performed in 9% (4/46) because of ALTR, 2% (1/46) septic loosening and 2% periprosthetic fracture. Both Cr and Co concentration increased over time, even though remaining at low level risk at 15 years: Co from 0.11 (+/- 0.18) to 4.29 (+/- 3.26) and Cr from 0.38 (+/- 0.32) to 1.37 (+/- 1.15). Functional scores in non-revised patients showed good to excellent results in more than 90%. Engh-score correlated with time from surgery (p = 0.017) and with sonographic, CT and RM findings (p < 0.05). Concordance has been found between CT and MRI findings (sign-rank test, p = 0.241; Intraclass Correlation Coefficients 0.987); however, no specific MRI or CT lesion patterns could be recognised among symptomatic and non-symptomatic patients. |
4 |
| 35. Kwon YM, Liow MH, Dimitriou D, Tsai TY, Freiberg AA, Rubash HE. What Is the Natural History of "Asymptomatic" Pseudotumours in Metal-on-Metal Hip Arthroplasty? Minimum 4-Year Metal Artifact Reduction Sequence Magnetic Resonance Imaging Longitudinal Study. J Arthroplasty 2016;31:121-6. |
Observational-Dx |
32 patients |
To (1) determine the natural history of pseudotumours in "asymptomatic" MoMHA patients under MARS-MRI surveillance and (2) characterize MRI feature(s) associated with progressive pseudotumours. |
At minimum of 4-year follow-up (range 49-54 months), 4 Type II pseudotumours (11%) demonstrated MRI evidence of progression. Five Type I pseudotumours (14%) were found to have "regressed." No measurable MRI progression was detected in remaining patients (75%). MRI features associated with progressive pseudotumours included the presence of increased cystic wall thickness and "atypical" mixed fluid signal. |
4 |
| 36. Matharu GS, Judge A, Eskelinen A, Murray DW, Pandit HG. What is appropriate surveillance for metal-on-metal hip arthroplasty patients?. Acta Orthop. 89(1):29-39, 2018 Feb. |
Review/Other-Dx |
N/A |
To discuss the various investigative modalities used during MoMHA surveillance, with specific focus on blood metal ion sampling and imaging. |
No results stated in abstract. |
4 |
| 37. Mistry A, Cahir J, Donell ST, Nolan J, Toms AP. MRI of asymptomatic patients with metal-on-metal and polyethylene-on-metal total hip arthroplasties. Clin Radiol. 2011;66:540-5. |
Review/Other-Dx |
22 total hip replacements in 20 asymptomatic patients |
To define and compare MRI findings of asymptomatic patients with MoM and polyethylene-on-metal total hip replacements. |
A range of MRI abnormalities are present in normal asymptomatic total hip replacements but the increased frequency of these associated with MoM total hip replacement suggest that some of these changes might represent subclinical disease. |
4 |
| 38. van der Weegen W, Smolders JM, Sijbesma T, Hoekstra HJ, Brakel K, van Susante JL. High incidence of pseudotumours after hip resurfacing even in low risk patients; results from an intensified MRI screening protocol. Hip Int 2013;23:243-9. |
Observational-Dx |
44 hips |
To clarify whether we should be alert to the presence of ‘silent’ pseudotumours in our cohort of hip resurfacing patients. |
The Anderson classification to grade any metal-on-metal (MoM) disease present on MARS-MRI images was used. In 15 out of 44 MRI scans pseudotumours were observed (34.1%), of which six were graded with mild (13.6%), eight with moderate (18.2%) and one with severe MoM disease (2.3%). Twelve pseudotumours were present in asymptomatic patients (27.3%). Metal ion levels were normal in 80% of the MARS-MRI screened patients. As a consequence of our intensified screening protocol, one patient was revised for pseudotumour formation and another patient was scheduled for revision. Silent pseudotumours were observed in all three groups. Before our intensified screening protocol was initiated, no pseudotumours were encountered in our cohort of 289 HRAs. |
2 |
| 39. Lainiala O, Elo P, Reito A, Pajamaki J, Puolakka T, Eskelinen A. Comparison of extracapsular pseudotumors seen in magnetic resonance imaging and in revision surgery of 167 failed metal-on-metal hip replacements. Acta Orthop 2014;85:474-9. |
Observational-Dx |
155 patients |
To evaluate the ability of preoperative MRI to detect extracapsular pseudotumors encountered in revision surgery and to assess appropriate intervals for repeated imaging, when development/progression of soft tissue pathologies is suspected. |
The sensitivity of MRI was 71% and the specificity was 87% for detecting extracapsular pseudotumors. The sensitivity was 88% (95% CI: 70-96) when MRI was performed less than 3 months before the revision surgery. Interestingly, when the time that elapsed between MRI and revision was more than 1 year, the sensitivity calculated was only 29% (95% CI: 14-56). Comparison between MRI and revision classifications gave moderate agreement (Cohen's kappa = 0.4). |
3 |
| 40. Liddle AD, Satchithananda K, Henckel J, et al. Revision of metal-on-metal hip arthroplasty in a tertiary center: a prospective study of 39 hips with between 1 and 4 years of follow-up. Acta Orthop 2013;84:237-45. |
Observational-Tx |
39 hips in 35 patients |
To report our experience with revision of MOMHA, in a multidisciplinary setting receiving tertiary referrals and employing sophisticated imaging techniques. |
We determined 5 categories of failure. 8 of 39 hips had conventional failure mechanisms including infection and impingement. Of the other 31 hips, 14 showed synovitis without significant disruption of soft tissue; 6 had a cystic pseudotumor with significant soft tissue disruption; 7 had significant osteolysis; and 4 had a solid pseudotumor. Each category of failure had specific surgical hazards that could be addressed preoperatively. There were 2 reoperations and 1 patient (2 hips) died of an unrelated cause. Median Oxford hip score (OHS) was 37 (9–48); median change (?OHS) was 17 (–10 to 41) points. ?OHS was similar in all groups—except those patients with solid pseudotumors and those revised to metal-on-metal bearings, who fared worse. |
1 |
| 41. Nishii T, Sakai T, Takao M, Yoshikawa H, Sugano N. Is ultrasound screening reliable for adverse local tissue reaction after hip arthroplasty? J Arthroplasty 2014;29:2239-44. |
Observational-Dx |
131 hips of 105 patients |
To examine reliability of US screening for adverse local tissue reaction in 131 hips of 105 patients who received both US and MRI examinations after hip arthroplasty with MoM or highly cross-linked polyethylene bearings. |
Using the MRI results as reference, sensitivity, specificity and accuracy of US were 74%, 92% and 84% around MoM bearings, and 90%, 83%, and 85% around highly cross-linked polyethylene bearings. US detected adverse local tissue reaction in 11 hips that were not shown with MRI. US examination is assumed to be a reliable screening tool for detecting clinically important adverse local tissue reaction lesions developing in the anterior region around MoM or highly cross-linked polyethylene bearings. |
2 |
| 42. Chang CY, Huang AJ, Palmer WE. Radiographic evaluation of hip implants. [Review]. Semin Musculoskelet Radiol. 19(1):12-20, 2015 Feb. |
Review/Other-Dx |
N/A |
To addresses the role of radiography following hip arthroplasty. |
No results stated in abstract. |
4 |
| 43. Hart AA, DeMik DE, Brown TS, Noiseux NO. Routine Radiographs After Total Joint Arthroplasty: Is There Clinical Value?. J Arthroplasty. 36(7):2431-2434, 2021 07. |
Review/Other-Tx |
885 patients |
To assess how frequently patients attend postoperative appointments and the clinical utility of routine radiographs after TJA. |
A total of 938 TJAs were performed, and 885 met inclusion criteria, with 423 (47.8%) total hip arthroplasties and 462 (52.2%) total knee arthroplasties. Eight hundred sixty-five (97.7%) patients attended a follow-up visit at 6 or 12 weeks and 589 (66.6%) attended at 1 year postoperatively. A single radiographic abnormality was detected, occurring at the 6- to 12-week period by the radiologist and interpreted as being an artifact by the surgeon. No additional radiographic abnormalities were detected at 1 year. Information from radiographs did not change clinical management for any patients. |
4 |
| 44. U.S. FDA: Concerns about Metal-on-Metal Hip Implants. Available at: https://www.fda.gov/medical-devices/metal-metal-hip-implants/concerns-about-metal-metal-hip-implants. |
Review/Other-Dx |
N/A |
To discuss unique risks of metal-on-metal (MoM) hip implants have unique risks. |
No results stated in abstract. |
4 |
| 45. Madanat R, Rolfson O, Donahue GS, et al. Medial Calcar Erosion Is Associated With Synovial Thickness in Patients With ASR XL Total Hip Arthroplasty. J Arthroplasty. 31(11):2588-2592, 2016 11. |
Observational-Dx |
96 patients |
To evaluate whether medial calcar erosion is also associated with adverse local tissue reactions (ALTR) in patients with standard stems in metal-on-metal (MoM) THA. |
Calcar erosion was present in 54 hips (50%) and was associated with ALTR synovial thickness but not with Anderson grade, diameter, or volume. Most of the hips with calcar erosion (n = 45) had an ALTR (positive predictive value 0.83, 95% confidence interval 0.70-0.92). The relative risk of having a synovial thickness > 3 mm increased by a factor of 3.0 (95% confidence interval 1.3-6.5) if calcar erosion was observed. |
2 |
| 46. Williams DH, Greidanus NV, Masri BA, Duncan CP, Garbuz DS. Prevalence of pseudotumor in asymptomatic patients after metal-on-metal hip arthroplasty. J Bone Joint Surg Am. 2011;93:2164-71. |
Review/Other-Dx |
31 patients with a MoM THA, 24 patients with a metal-on-polyethylene THA, and 20 patients with a MoM hip resurfacing arthroplasty |
To assess the prevalence of pseudotumor formation in asymptomatic patients with a MoM total hip replacement after a minimum duration of follow-up of 2 years. A secondary purpose was to assess whether a correlation exists between elevated serum metal ion levels and pseudotumor formation. |
10 patients (32%) in the MoM THA group had a solid or cystic mass, with another 3 patients (10%) having a substantial fluid collection. 5 patients (25%) in the hip resurfacing arthroplasty group had a solid or cystic mass, with another patient (5%) having a fluid collection. Pseudotumor formation was significantly more frequent in the MoM THA group compared with the metal-on-polyethylene THA group (P=0.015). The authors did not detect a significant correlation between the serum metal ion levels and the size of pseudotumor abnormality. The median serum metal ion level was greater in patients with pseudotumor formation than it was in those without pseudotumor formation, but the difference was not significant. |
4 |
| 47. Douis H, Dunlop DJ, Pearson AM, O'Hara JN, James SL. The role of ultrasound in the assessment of post-operative complications following hip arthroplasty. Skeletal Radiol. 2012;41:1035-46. |
Review/Other-Dx |
N/A |
To describe the common surgical approaches used during hip arthroplasty as this can influence the nature and location of subsequent complications. A review of the literature is presented along with the imaging appearances frequently encountered when imaging this patient population. |
No results stated in abstract. |
4 |
| 48. Kwon YM, Ostlere SJ, McLardy-Smith P, Athanasou NA, Gill HS, Murray DW. "Asymptomatic" pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalence and metal ion study. J Arthroplasty. 2011;26:511-8. |
Review/Other-Dx |
201 hips in 158 patients |
To determine the prevalence of asymptomatic pseudotumors after MoM hip resurfacing arthroplasty and to measure metal ion levels in these patients. |
Pseudotumors found in 7 patients (4%) were associated with significantly higher cobalt and chromium levels and inferior functional scores. Elevated levels of cobalt and chromium ions suggest that pseudotumors are associated with increased wear generated from MoM articulations. |
4 |
| 49. Petscavage-Thomas JM, Ha A. Best Practices: Best Imaging Modality for Surveillance of Metal-on-Metal Hip Arthroplasty. AJR Am J Roentgenol 2021;216:311-17. |
Review/Other-Dx |
N/A |
To provide an up-to-date literature review of current recommendations for surveillance imaging of patients who have undergone MOM hip arthroplasty. |
No results stated in abstract. |
4 |
| 50. Low AK, Matharu GS, Ostlere SJ, Murray DW, Pandit HG. How Should We Follow-Up Asymptomatic Metal-on-Metal Hip Resurfacing Patients? A Prospective Longitudinal Cohort Study. J Arthroplasty. 31(1):146-51, 2016 Jan. |
Observational-Dx |
152 asymptomatic MoMHRs |
To assess factors associated with (1) ultrasound finding progression and (2) developing new pseudotumors. |
Ultrasound progression was observed in 19% (n = 29), with 10% (n = 15) developing new pseudotumors. Key predictors of ultrasound progression included high blood cobalt (P = .00013) and chromium (P = .00065), and high initial ultrasound grade (P = .003) and volume (P = .036). No asymptomatic MoMHRs with initially normal metal ions (< 2 µg/L) and normal ultrasounds (33% of cohort) developed new pseudotumors. |
3 |
| 51. Lainiala O, Elo P, Reito A, Pajamaki J, Puolakka T, Eskelinen A. Good sensitivity and specificity of ultrasound for detecting pseudotumors in 83 failed metal-on-metal hip replacements. Acta Orthop 2015;86:339-44. |
Observational-Dx |
82 patients with MoM hip replacement |
To evaluate the sensitivity and specificity of US for detecting pseudotumors in a cohort of patients with failed MoM hip replacements. |
Ultrasound had a sensitivity of 83% (95% CI: 63-93) and a specificity of 92% (CI: 82-96) for detecting trochanteric region pseudotumors, and a sensitivity of 79% (CI: 62-89) and a specificity of 94% (CI: 83-98) for detecting iliopsoas-region pseudotumors. Type misclassification of pseudotumors found at revision occurred in 8 of 23 hips in the trochanteric region and in 19 of 33 hips in the iliopsoas region. |
3 |
| 52. Kwon YM, Dimitriou D, Liow MH, Tsai TY, Li G. Is Ultrasound As Useful As Metal Artifact Reduction Sequence Magnetic Resonance Imaging in Longitudinal Surveillance of Metal-on-Metal Hip Arthroplasty Patients? J Arthroplasty 2016;31:1821-7. |
Observational-Dx |
35 MoM patients (42 hips) |
To evaluate the diagnostic accuracy of ultrasound in comparison with MARS MRI in detecting ALTR in MoM patients during consecutive follow-up. |
At the initial evaluation and at the subsequent follow-up, ultrasound had a sensitivity of 81% and 86% and a specificity of 92% and 88%, respectively. At the follow-up evaluations, ultrasound was able to detect the "change" in the lesions size with -0.3 cm(2) average bias from the MARS MRI with higher agreement (k = 0.85) with MARS MRI compared to the initial evaluation in detecting any "change" in ALTR size or grade. |
3 |
| 53. Endo Y, Renner L, Schmidt-Braekling T, Mintz DN, Boettner F. Imaging of ceramic liner fractures in total hip arthroplasty: the value of CT. Skeletal Radiol. 44(8):1189-92, 2015 Aug. |
Review/Other-Tx |
2 patients |
To report on two patients in whom ceramic liner fracture was radiographically occult but was diagnosed on subsequent CT scan through appropriate windowing. |
No results stated in abstract. |
4 |
| 54. Matharu GS, Blanshard O, Dhaliwal K, Judge A, Murray DW, Pandit HG. Patient and Radiographic Factors Help to Predict Metal-on-Metal Hip Resurfacings with Evidence of a Pseudotumor. J Bone Joint Surg Am 2017;99:214-22. |
Observational-Dx |
384 MoMHRs |
To investigate whether a combination of patient and radiographic factors can predict metal-on-metal hip resurfacing (MoMHR) implants with evidence of a pseudotumor. |
Patient and radiographic factors predictive of revision for pseudotumor in the multivariable model were female sex (odds ratio [OR], 3.14; 95% confidence interval [CI], 1.85 to 5.35; p < 0.001), high inclination (OR, 1.04 per degree; 95% CI, 1.01 to 1.07 per degree; p = 0.006), acetabular osteolysis (OR, 5.06; 95% CI, 2.14 to 12.0; p < 0.001), femoral osteolysis (OR, 17.8; 95% CI, 5.09 to 62.2; p < 0.001), and acetabular loosening (OR, 3.35; 95% CI, 1.34 to 8.35; p = 0.009). Factors predictive of not having a pseudotumor were anteversion of =5° (5° to <10°: OR, 0.31; 95% CI, 0.12 to 0.77; p = 0.012; and =10°: OR, 0.32; 95% CI, 0.15 to 0.70; p = 0.004) and heterotopic ossification (OR, 0.19; 95% CI, 0.05 to 0.72; p = 0.015). The final multivariable model was well calibrated (p = 0.589), with good discriminatory ability (area under the curve = 0.801; sensitivity = 74.4%; specificity = 71.7%). |
2 |
| 55. Chong AC, MacFadden LN, Piatt BE, Noonan BC. Is Plain Anterior-Posterior Radiograph of the Pelvis Adequate for Assessment of Radiographic Implant Migration Evaluation in Total Hip Arthroplasty?. Iowa Orthop J. 40(1):53-60, 2020. |
Observational-Dx |
200 patients |
To validate the reproducibility of using serial digitized plain AP pelvis radiographs to perform radiological displacement measurements and image magnification. |
Two hundred THA patients met the inclusion/ exclusion criteria. The intra-radiograph reproducibility of the stem length and head diameter measurements have at least "good" reproducibility with repeated measurements falling within 0.5 mm for both measurements. The reliability for femoral stem seating length measurements has "questionable/poor" reproducibility. The inter-radiograph reproducibility was, however, substantially lower. High level of unreliable measurements with values less than 0.0 mm for both femoral stem length errors (55%) and femoral stem subsidence (32%) measurements. Less than 45% accuracy (femoral stem length error: 33%; femoral stem subsidence: 44%) to within 3 mm error. |
3 |
| 56. Kwon YM, An S, Yeo I, Tirumala V, Chen W, Klemt C. Radiographic Risk Factors Associated With Adverse Local Tissue Reaction in Head-Neck Taper Corrosion of Primary Metal-on-Polyethylene Total Hip Arthroplasty. J Am Acad Orthop Surg. 29(8):353-360, 2021 Apr 15. |
Observational-Dx |
146 MoP THA patients |
To identify any potential clinical risk factors associated with failed MoP THA due to head-neck taper corrosion. |
The occurrence of ALTR was associated with increased radiographic femoral stem offset (36.0 ± 7.7 mm versus 40.8 ± 7.3 mm, P = 0.008), increased femoral head offset (0.7 ± 3.4 versus 4.5 ± 3.7, P < 0.001), and the use of Ti-12Mo-6Zr-2Fe alloy stems (P = 0.041). The presence of ALTR was notably associated with higher chromium (2.0 versus 0.5 µg/L) and cobalt (7.4 versus 0.7 µg/L, P < 0.001). |
2 |
| 57. Mastel M, Boisvert A, Moore R, Sutherland F, Powell J. Metallosis following hip arthroplasty: two case reports. J Med Case Rep 2022;16:115. |
Review/Other-Tx |
Two patients |
To present two pseudotumor cases that were excised through a combined approach. |
No results stated in abstract. |
4 |
| 58. Paydar A, Chew FS, Manner PA. Severe Periprosthetic Metallosis and Polyethylene Liner Failure Complicating Total Hip Replacement: The Cloud Sign. Radiol Case Rep 2007;2:115. |
Review/Other-Dx |
1 patient |
To present a case of an 85-year-old woman with extensive metallosis of the left hip joint secondary to prosthetic polyethelene liner dislocation and wear. |
Radiographs demonstrated amorphous cloudy radiodensities surrounding the prosthesis, a feature we have called the "cloud sign." |
4 |
| 59. Su EP, Callander PW, Salvati EA. The bubble sign: a new radiographic sign in total hip arthroplasty. J Arthroplasty 2003;18:110-2. |
Review/Other-Dx |
1 patient |
To describe a case of extreme generation of metallic debris that resulted in the radiographic outlining of the joint cavity. |
At the time of revision surgery, copious metallic debris was seen macroscopically. |
4 |
| 60. Tigges S, Stiles RG, Roberson JR. Appearance of septic hip prostheses on plain radiographs. J Bone Joint Surg Am. 1994;163:377-80. |
Review/Other-Dx |
20 hip prostheses |
To evaluate the spectrum of plain radiographic findings in patients with septic hip prostheses. |
Findings were normal in 10 prostheses, but nonfocal lucencies mimicking mechanical loosening were seen in 4 cases. 2 cases showed focal bone loss, indistinguishable from aggressive granulomatosis. A variety of findings, including subsidence and periostitis, were seen in the remaining 4 prostheses. |
4 |
| 61. Stumpe KD, Notzli HP, Zanetti M, et al. FDG PET for differentiation of infection and aseptic loosening in total hip replacements: comparison with conventional radiography and three-phase bone scintigraphy. Radiology. 2004;231:333-41. |
Observational-Dx |
35 patients |
To compare the diagnostic efficacy of FDG-PET with that of conventional radiography and three-phase bone scintigraphy in patients suspected of having infection in their total hip replacements. |
9 patients had septic and 21 patients had aseptic loosening. In 5 patients, neither loosening nor infection was confirmed. For diagnosing infection with FDG-PET, conventional radiography, and bone scintigraphy, respectively, sensitivity values for reader 1 and reader 2 were 33% and 22%, 89% and 78%, and 56% and 44%, while specificity values were 81% and 85%, 50% and 65%, and 88% and 92% and accuracy values were 69% for both readers, 60% and 69%, and 80% for both readers. PET was significantly more specific (P=.035) but less sensitive (P=.016) than conventional radiography for the diagnosis of infection. |
2 |
| 62. Steinert L, Zanetti M, Hodler J, Pfirrmann CW, Dora C, Saupe N. Are radiographic trochanteric surface irregularities associated with abductor tendon abnormalities? Radiology. 2010;257(3):754-763. |
Observational-Dx |
150 patients |
To assess the association between trochanteric surface irregularities seen on conventional radiographs and MRI evidence of abductor tendon abnormalities. |
The PPV of surface irregularities >2 mm for MR tendinopathy or a partial- or full-thickness tear was 90% (37/41 patients). The sensitivity of radiographic changes was 40%; the specificity, 94%; the accuracy, 61%; the NPV, 49%; and the positive likelihood ratio, 5.8. Interobserver agreement for detection of trochanteric surface irregularities on conventional radiographs ranged from 0.28 to 0.76. |
2 |
| 63. Barrett MC, Robertson-Waters EE, Whitehouse MR, Blom AW, Berstock JR. Trochanteric spurs and surface irregularities on plain radiography are not predictive of greater trochanteric pain syndrome. Hip int.. 30(2):176-180, 2020 Mar. |
Observational-Dx |
38 patients and 100 controls. |
To evaluate the clinical usefulness of trochanteric surface irregularities on plain radiographs in the diagnosis of GTPS. |
The inter-observer correlation coefficient agreement was acceptable at 0.75 (95% CI, 0.60-0.84). Trochanteric surface irregularities including frank spurs protruding ?2 mm were associated with a 24.7% positive predictive value, 64.0% sensitivity, 25.7% specificity, 74.3% false-positive rate, 36.0% false-negative rate, and a 65.3% negative predictive value for clinical GTPS. |
2 |
| 64. Mulcahy H, Chew FS. Current concepts of hip arthroplasty for radiologists: part 2, revisions and complications. AJR Am J Roentgenol 2012;199:570-80. |
Review/Other-Dx |
N/A |
To reviews the imaging features of revisions and complications of hip replacement arthroplasty and relates these features to the current understanding about how and why these failures occur. |
No results stated in abstract. |
4 |
| 65. Kwon YM, Lombardi AV, Jacobs JJ, Fehring TK, Lewis CG, Cabanela ME. Risk stratification algorithm for management of patients with metal-on-metal hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and the Hip Society. J Bone Joint Surg Am 2014;96:e4. |
Review/Other-Dx |
N/A |
To present a risk stratification algorithm for management of patients with metal-on-metal hip arthroplasty. |
No results stated in abstract. |
4 |
| 66. Matharu GS, Mansour R, Dada O, Ostlere S, Pandit HG, Murray DW. Which imaging modality is most effective for identifying pseudotumours in metal-on-metal hip resurfacings requiring revision: ultrasound or MARS-MRI or both?. Bone Joint J. 98-B(1):40-8, 2016 Jan. |
Observational-Dx |
39 patients |
To compare the diagnostic test characteristics of ultrasound alone, metal artefact reduction sequence MRI (MARS-MRI) alone, and ultrasound combined with MARS-MRI for identifying intra-operative pseudotumours in metal-on-metal hip resurfacing (MoMHR) patients undergoing revision surgery. |
Agreement with the intra-operative findings was 82.5% (n = 33) for ultrasound alone, 87.5% (n = 35) for MARS-MRI alone, and 92.5% (n = 37) for ultrasound and MARS-MRI combined. The diagnostic characteristics for ultrasound alone and MARS-MRI alone reached similar sensitivities (90.9% vs 93.9%) and positive predictive values (PPVs; 88.2% vs 91.2%), but higher specificities (57.1% vs 42.9%) and negative predictive values (NPVs; 66.7% vs 50.0%) were achieved with MARS-MRI. Ultrasound and MARS-MRI combined produced 100% sensitivity and 100% NPV, whilst maintaining both specificity (57.1%) and PPV (91.7%). For the identification of a pseudotumour, which was confirmed at revision surgery, agreement was substantial for ultrasound and MARS-MRI combined (? = 0.69), moderate for MARS-MRI alone (? = 0.54), and fair for ultrasound alone (? = 0.36). |
2 |
| 67. Andriamananaivo T, Odri GA, Ollivier M, et al. Contribution of the remaining attachment index in the management of Vancouver B1 periprosthetic hip fracture. Orthop Traumatol Surg Res. 106(7):1413-1417, 2020 Nov. |
Observational-Dx |
50 patients |
To assess the correlation between radiographic Remaining Attachment Index (RAI) and risk of implant loosening at last follow-up following internal fixation of Vancouver B1 periprosthetic hip fracture. |
Two RAI>2/3 patients showed implant loosening (8%) versus 9 RAI<2/3 patients (36%), disclosing a significant correlation between early loosening and RAI<2/3 (p=0.005). Interobserver agreement for both radiographic RAI and radiographic loosening assessment at last follow-up was 98% with kappa correlation coefficient 0.96 [range: 0.88-1]. |
3 |
| 68. Baba T, Homma Y, Ochi H, et al. Higher reliability and validity of Baba classification with computerised tomography imaging and implant information for periprosthetic femoral fractures. Int Orthop. 39(9):1695-9, 2015 Sep. |
Observational-Dx |
20 patients |
To investigate whether the addition of CT images and implant information to plain radiograms increases the reliability of Baba classification to a level higher than that of Vancouver classification. |
When interobserver reliability was made based on only radiograms, the mean value of Baba classification-based judgments made by the experts was 0.76, and those of Vancouver classification-based judgments made by the experts was 0.41. When interobserver reliability was made based on the radiograms and CT images and implant information, the mean ? value of Baba classification-based judgments made by the experts was 0.94, and those of Vancouver classification-based judgments were 0.48. Intra-observer reliability of Baba classification was 0.81 in the experts. Validity analysis showed 95.0% agreement within all subgroups. |
3 |
| 69. Cinotti G, Sinno E, Fornara G, LaTorre G, Giannicola G. Plain films are not accurate in planning internal fixation in vancouver type B1 periprosthetic femoral fractures and in distinguishing between subtypes B1 And B2. Injury. 52(6):1592-1596, 2021 Jun. |
Observational-Dx |
36 dried cadaveric femurs |
To analyze the diagnostic validity of radiographs in detecting the fracture course and stem stability in Vancouver type B PFFs. |
The identification of the fracture course was scored as poor in 52.4% and 56.%, fair in 23% and 23.4% and good in 24.6% and 19.8%, The identification of the fracture course in the coronal and axial vies radiographs was scored in coronal and axial views radiographs respectively. There was no significant difference in the average score obtained by senior and young examiners. In the coronal plane, the fracture course was poorly identified by all examiners in 11 (30.5%) femurs and by 5 or more examiners in 17 (47%). The fracture course was correctly identified by 5 or more examiners in 8 femurs (22%). A vertical fracture involving an emidiaphysis was found in 8 of the 11 femurs in which the PFF was poorly diagnosed by all examiners. Stem instability was correctly diagnosed in 45% of cases. |
2 |
| 70. Marshall RA, Weaver MJ, Sodickson A, Khurana B. Periprosthetic Femoral Fractures in the Emergency Department: What the Orthopedic Surgeon Wants to Know. Radiographics 2017;37:1202-17. |
Review/Other-Dx |
N/A |
To review the normal appearance of the most common femoral prostheses, the risk factors and mechanisms of periprosthetic femoral fractures, and the most common femoral fracture patterns encountered in an emergency department (ED) setting. |
No results stated in abstract. |
4 |
| 71. Rupp M, Kern S, Ismat A, et al. Computed tomography for managing periprosthetic femoral fractures. A retrospective analysis. BMC Musculoskelet Disord. 20(1):258, 2019 May 29. |
Observational-Dx |
75 patients |
To examine the role of CT as a diagnostic modality and its implications for treatment planning and outcome. |
X-ray imaging was performed in 90.7% of cases. CT was performed in 60% of the cases as part of the preoperative diagnostic. A clear statement on implant stability or loosening could not be made in 69.1% after X-ray imaging and in 84.4% following CT imaging. Revision arthroplasty for loosened femoral prosthesis components was necessary in 40% of cases. |
3 |
| 72. Burge AJ.. Total hip arthroplasty: MR imaging of complications unrelated to metal wear. [Review]. Semin Musculoskelet Radiol. 19(1):31-9, 2015 Feb. |
Review/Other-Dx |
NA |
No objective stated in abstract. |
No results stated in abstract. |
4 |
| 73. Long SS, Surrey D, Nazarian LN. Common sonographic findings in the painful hip after hip arthroplasty. J Ultrasound Med. 2012;31(2):301-312. |
Review/Other-Dx |
N/A |
To highlight commonly encountered sonographic findings in patients with hip pain after hip arthroplasty. |
Sonography plays an important role in the diagnosis and management of patients with hip arthroplasty because the soft tissues surrounding the prosthetic joint are not obscured by artifacts and because sonography enables hands-on examination of the painful site, dynamic evaluation of moving structures, and comparison with the opposite side. Another advantage of sonography is the ability to perform sonographically guided diagnostic and therapeutic procedures. |
4 |
| 74. Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty. 2009;24:105-9. |
Review/Other-Dx |
887 THA infections identified from 39,929 THA patients |
To evaluate the incidence of early-onset (<2 years) and late-onset (>2 years) periprosthetic joint infection after primary THA. |
The incidence of infection was 1.63% within 2 years and 0.59% between 2 and 10 years. Comorbidities, sex, procedure duration, and socioeconomic status were found to be significant risk factors. |
4 |
| 75. Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint I. Definition of periprosthetic joint infection. J Arthroplasty 2014;29:1331. |
Review/Other-Dx |
N/A |
Editorial on the definition of periprosthetic joint infection. |
No results stated in abstract. |
4 |
| 76. Chen AF, Riedel S. A Case Illustrating the Practical Application of the AAOS Clinical Practice Guideline: Diagnosis and Prevention of Periprosthetic Joint Infection. J Am Acad Orthop Surg 2020;28:e1081-e85. |
Review/Other-Dx |
na |
No objective stated in abstract. |
No results stated in abstract. |
4 |
| 77. Gomez-Luzuriaga MA, Galan V, Villar JM. Scintigraphy with Tc, Ga and In in painful total hip prostheses. Int Orthop. 1988;12:163-7. |
Observational-Dx |
40 patients |
To study a series of patients who were operated upon for a painful total hip prosthesis, half of which were infected. In each case, preoperative scintigraphy was performed using Tc-99m, Ga67 and In-111. |
In-111 had a predictive value of more than 90% and showed greater reliability in the diagnosis of an infection as the cause of a painful total hip prosthesis. |
3 |
| 78. Kraemer WJ, Saplys R, Waddell JP, Morton J. Bone scan, gallium scan, and hip aspiration in the diagnosis of infected total hip arthroplasty. J Arthroplasty 1993;8:611-6. |
Observational-Dx |
72 patients |
To review of the efficacy of the preoperative investigations used at the authors' institution. |
Twenty infected hips were detected on culture. For prediction of infection, the bone-gallium scan had a sensitivity of 38% and a specificity of 100%. Hip aspiration had a sensitivity of 57% and a specificity of 97%. The investigations combined gave a sensitivity of 64% and a specificity of 95%. Intraoperative Gram stain compared with subsequent culture yielded a sensitivity of 23% and a specificity of 100%. Uncemented hips were infected more frequently (47%) than cemented hips (9%), significant at P < .0001. |
3 |
| 79. Tehranzadeh J, Gubernick I, Blaha D. Prospective study of sequential technetium-99m phosphate and gallium imaging in painful hip prostheses (comparison of diagnostic modalities). Clin Nucl Med. 1988;13:229-36. |
Observational-Dx |
22 hip prostheses in 21 patients |
22 painful hip prostheses were studied prospectively with plain radiography, aspiration and arthrography, Tc-99m phosphate bone imaging, and gallium imaging to evaluate loosening, infection, or both and to compare the accuracy of these modalities. |
15 prostheses were revised yielding 14 loose femoral and 8 loose acetabular components. 5 proved to have infected prostheses. Arthrograms, plain radiographs, and bone scans are highly sensitive in detecting loosening of the femoral component. |
3 |
| 80. Hill DS, Naim S, Powell RJ, Kinsella D, Toms AD, Howell J. 3-phase Technicium-99m bone scanning in patients with pain in the hip region after cemented total hip replacement: a multicentre series of 100 cases. Hip International. 28(3):259-265, 2018 May. |
Observational-Dx |
100 patients |
To assess the benefit of a Technetium-99M (HDP) 3-phase bone scan (TPBS) as an additional diagnostic test in the evaluation of pain in the hip region following cemented total hip replacement (THR) surgery. |
45% (45) of TPBSs were reported as being entirely normal, 50% (50) as possibly abnormal, and 5% (5) as definitely abnormal. During the 24-month study period 230 revision THR procedures were performed at our institution; 10% (24) were investigated with TPBS and 90% (206) were not. 29% (7/24) of patients investigated with a TPBS that subsequently underwent revision THR surgery had an entirely normal preoperative TPBS. 84% (38) with an abnormal TPBS were managed conservatively. A TPBS had a sensitivity of 29% (95% confidence interval (CI), 13%-51%) and a specificity of 50% (95% CI, 38%-62%) in the detection of infection, or loosening with concurrent infection. |
2 |
| 81. Nagoya S, Kaya M, Sasaki M, Tateda K, Yamashita T. Diagnosis of peri-prosthetic infection at the hip using triple-phase bone scintigraphy. J Bone Joint Surg Br. 2008;90:140-4. |
Observational-Dx |
46 patients |
To evaluate TPBS in the differential diagnosis of peri-prosthetic infection in patients with a total hip replacement or bipolar hemiarthroplasty who were due for revision surgery. |
The PPVs and NPVs for the presence of infection were 83% and 93%, respectively. The diagnostic sensitivity was 88% and the specificity was 90%. This study indicates that TPBS is a useful tool in the detection of peri-prosthetic infection and offers a cost-effective method of screening. |
3 |
| 82. Reinartz P, Mumme T, Hermanns B, et al. Radionuclide imaging of the painful hip arthroplasty: positron-emission tomography versus triple-phase bone scanning. J Bone Joint Surg Br. 2005;87:465-70. |
Observational-Dx |
63 patients (92 prostheses) |
To assess the diagnostic ability of TPBS and PET to detect and differentiate these complications in patients with a hip arthroplasty. |
The sensitivity, specificity and accuracy of PET was 0.94, 0.95 and 0.95 respectively, compared with 0.68, 0.76 and 0.74 for TPBS. The authors found that an image interpretation based exclusively upon quantitative criteria was inappropriate because of its low selectivity. The histological examination indicated that increased periprosthetic uptake of FDG in patients with aseptic loosening was caused by wear-induced polyethylene particles and the subsequent growth of aggressive granulomatous tissue. |
2 |
| 83. Schweizer T, Schiapparelli FF, Rotigliano N, Rasch H, Amsler F, Hirschmann MT. Patterns of bone tracer uptake on SPECT-CT in symptomatic and asymptomatic patients with primary total hip arthroplasty. Eur J Nucl Med Mol Imaging. 45(2):283-291, 2018 Feb. |
Observational-Dx |
58 THAs |
To compare bone tracer uptake (BTU) on SPECT/CT in symptomatic and asymptomatic total hip arthroplasty (THA) and identify a possible relationship between BTU patterns and patient's symptoms. |
The causes of pain were identified in 61% of the patients. The most common problem was aseptic loosening (n = 12). In group AS, levels 1, 2 and 5 had similar BTUs. BTUs in these levels were significantly higher than in level 3, 4 and 6. In group S, no significant differences were seen in terms of BTU in level 1-5. However, BTU here was significantly higher than at level 6 (p < 0.001). In both groups, level 1, the superior, had a significantly higher BTU than level 2 (group AS p < 0.01, group S p < 0.05). Comparing the BTU of the two groups among levels, significant differences were found for level 4, level 5 and the entire stem areas (p < 0.05). The ROC curve calculated on the whole stem allowed identification of a BTU ratio of 3.1 that separated the 92.6% patients of group AS with BTU < 3.1 from the 54.8% of patients of group S with a BTU = 3.1. With regards to the fixation technique, only the BTU at the level 6 in group S presented a significant difference between cemented and uncemented stems (p < 0.05). |
2 |
| 84. Cyteval C, Hamm V, Sarrabere MP, Lopez FM, Maury P, Taourel P. Painful infection at the site of hip prosthesis: CT imaging. Radiology. 2002;224:477-83. |
Observational-Dx |
65 patients |
To prospectively determine the accuracy of CT in the detection of painful infection at the site of hip prosthesis before surgery. No intravenous contrast was administered. |
Infection was detected clinically in 25% of patients. Periprosthetic bone abnormalities did not allow differentiation of infection from complications not related to sepsis, except for periostitis, with 100% specificity but only 16% sensitivity. Soft-tissue findings were accurate for detection of infection, with 100% sensitivity and 87% specificity. Fluid collection in muscles and perimuscular fat had a 100% PPV, and absence of joint distention had a 96% NPV. |
2 |
| 85. Isern-Kebschull J, Tomas X, Garcia-Diez AI, et al. Value of multidetector computed tomography for the differentiation of delayed aseptic and septic complications after total hip arthroplasty. Skeletal Radiol. 49(6):893-902, 2020 Jun. |
Observational-Dx |
96 patients |
To investigate the utility of multidetector computed tomography (CT) findings to diagnose aseptic mechanical loosening, granulomatous reaction, and periprosthetic joint infection in patients who underwent total hip arthroplasty before revision surgery. |
Multidetector CT-related variables independently associated with periprosthetic joint infection were high periprosthetic soft-tissue accumulation, periprosthetic osteolysis without expansile periosteal reaction and enlarged iliac lymph nodes. On the other hand, the absence of the following radiological signs: low or high periprosthetic soft-tissue accumulation, mild or severe periprosthetic osteolysis, and enlarged iliac lymph nodes, were predictors of aseptic mechanical loosening. Low periprosthetic soft-tissue accumulation, severe periprosthetic osteolysis with expansile periosteal reaction, and mild acetabular malposition were significant variables associated with granulomatosis. |
2 |
| 86. Chryssikos T, Parvizi J, Ghanem E, Newberg A, Zhuang H, Alavi A. FDG-PET imaging can diagnose periprosthetic infection of the hip. Clin Orthop Relat Res. 2008;466:1338-42. |
Observational-Dx |
113 patients with 127 painful hip prostheses |
Prospective study to determine the accuracy of FDG-PET imaging in diagnosing periprosthetic infection in a large multicenter setting. |
Among the 35 positive PET scans, 28 hips were confirmed infected according to the criteria for diagnosing periprosthetic infection. Of the 92 hip prostheses with negative FDG-PET findings, 87 were considered aseptic. The sensitivity, specificity, PPV and NPV for FDG-PET were 0.85 (28/33), 0.93 (87/94), 0.80 (28/35), and 0.95 (87/92), respectively. The overall accuracy of this novel noninvasive imaging modality reached 0.91 (115/127). |
2 |
| 87. Mumme T, Reinartz P, Alfer J, Muller-Rath R, Buell U, Wirtz DC. Diagnostic values of positron emission tomography versus triple-phase bone scan in hip arthroplasty loosening. Arch Orthop Trauma Surg. 2005;125:322-9. |
Observational-Dx |
50 patients with 70 total hip replacements |
To examine the diagnostic valency of FDG-PET in cases of septic or aseptic hip arthroplasty loosening compared with conventional TPBS. |
Sensitivity/specificity of FDG-PET was 91%/92% (accuracy 91%) compared with 78%/70% (accuracy 74%) for TPBS. A high correlation could be proved between FDG-PET investigation and operative histopathological findings (r(Spear =0.9). No significant differences were found regarding cemented and uncemented implanted hip arthroplasties (P=0.05). Calculation of the SUV turned out to be inappropriate as a sole criterion for image interpretation. |
3 |
| 88. Pill SG, Parvizi J, Tang PH, et al. Comparison of fluorodeoxyglucose positron emission tomography and (111)indium-white blood cell imaging in the diagnosis of periprosthetic infection of the hip. J Arthroplasty. 2006;21:91-7. |
Observational-Dx |
89 patients with 92 painful hip prostheses |
To compare the accuracy of FDG-PET with Tc-99m sulfur colloid In-111-labeled WBC scintigraphy in diagnosis of periprosthetic infection. |
FDG-PET correctly diagnosed 20/21 infected cases (sensitivity, 95.2%) and ruled out infection in 66/71 aseptic hips (specificity, 93%) corresponding to a PPV of 80% (20/25) and a NPV of 98.5% (66/67). Tc-99m sulfur colloid In-111-labeled WBC scintigraphy correctly identified 5/10 infected cases (sensitivity, 50%) and 39/41 aseptic cases (specificity, 95.1%) corresponding to a PPV and NPV of 41.7% (5/12 cases) and 88.6% (39/44 cases), respectively. |
2 |
| 89. Verberne SJ, Temmerman OPP, Vuong BH, Raijmakers PG. Fluorodeoxyglucose positron emission tomography imaging for diagnosing periprosthetic hip infection: the importance of diagnostic criteria. Int Orthop. 42(9):2025-2034, 2018 09. |
Observational-Dx |
33 hip prostheses |
To evaluate the various diagnostic criteria using FDG-PET in diagnosing periprosthetic hip infection. |
Any periprosthetic FDG uptake was found in all symptomatic prostheses (sensitivity 100%; specificity 0%). When increased uptake in the bone-prosthesis-interface (sensitivity 100%; specificity 65%) or PST (sensitivity 94%; specificity 59%) was considered infected, specificity increased. A higher intensity of uptake at the bone-prosthesis-interface than PST demonstrated only moderate specificity (sensitivity 44%; specificity 71%). The most specific criterion for infection was an increased FDG uptake along the femoral bone-prosthesis-interface (sensitivity 81%; specificity 94%). |
3 |
| 90. Zhuang H, Duarte PS, Pourdehnad M, et al. The promising role of 18F-FDG PET in detecting infected lower limb prosthesis implants. J Nucl Med. 2001;42(1):44-48. |
Observational-Dx |
74 prostheses in 62 patients |
To evaluate the feasibility of using FDG-PET for the detection of infection associated with lower limb arthroplasty. |
The sensitivity, specificity, and accuracy of PET for detecting infection associated with knee prostheses were 90.9%, 72.0%, and 77.8%, respectively. The sensitivity, specificity, and accuracy of PET for detecting infection associated with hip prostheses were 90%, 89.3%, and 89.5%, respectively. Overall, the sensitivity was 90.5% and the specificity was 81.1% for detection of lower limb infections. |
3 |
| 91. Garcia-Barrecheguren E, Rodriguez Fraile M, Toledo Santana G, Valenti Nin JR, Richter Echevarria JA. [FDG-PET: a new diagnostic approach in hip prosthetic replacement]. Rev Esp Med Nucl. 2007;26(4):208-220. |
Observational-Dx |
24 hip joint replacements |
To evaluate the utility of FDG-PET imaging for diagnosing infected joint replacements. |
The sensitivity and specificity of PET for detecting infection associated with prostheses were 64.3% and 64.7%, respectively. FDG imaging is not useful in patients with suspected prosthetic infection as a screening test. |
2 |
| 92. Kiran M, Donnelly TD, Armstrong C, Kapoor B, Kumar G, Peter V. Diagnostic utility of fluorodeoxyglucose positron emission tomography in prosthetic joint infection based on MSIS criteria. Bone Joint J. 101-B(8):910-914, 2019 Aug. |
Observational-Dx |
130 painful unilateral cemented THAs |
To analyze the utility of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT scan in the preoperative diagnosis of septic loosening in THA, based on the current MSIS definition of prosthetic joint infection. |
The mean erythrocyte sedimentation rate, C-reactive protein, and white cell count were 47.83 mm/hr, 25.21 mg/l, and 11.05 × 109/l, respectively. The sensitivity, specificity, accuracy, negative predictive value, and false-positive rate of FDG PET compared with MSIS criteria were 94.87%, 38.46 %, 56.38%, 94.59 %, and 60.21%, respectively. The false-positive rate of FDG PET compared with culture alone was 77.4%. |
3 |
| 93. Kwee RM, Broos WA, Brans B, Walenkamp GH, Geurts J, Weijers RE. Added value of 18F-FDG PET/CT in diagnosing infected hip prosthesis. Acta Radiol. 59(5):569-576, 2018 May. |
Observational-Dx |
78 patients |
To investigate the added value of 18F-FDG PET/CT to conventional tests including radiography, erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) testing, and joint aspiration, in diagnosing infected hip prosthesis. |
The addition of 18F-FDG PET/CT increased AUCs: for radiography with 0.212, P = 0.001; for ESR/CRP testing with 0.076, P = 0.072; for aspiration culture with 0.126, P = 0.032; and for aspiration WBC count with 0.191, P = 0.035. |
3 |
| 94. Delank KS, Schmidt M, Michael JW, Dietlein M, Schicha H, Eysel P. The implications of 18F-FDG PET for the diagnosis of endoprosthetic loosening and infection in hip and knee arthroplasty: results from a prospective, blinded study. BMC Musculoskelet Disord. 2006;7:20. |
Observational-Dx |
27 patients |
To evaluate the clinical value of FDG PET as a diagnostic modality for inflammation and loosening in hip and knee joint prostheses. |
Evidence of loosening was correctly determined in 76.4% of cases using FDG-PET, and in 75% of cases using bone scan. The detection of periprosthetic inflammation using FDG-PET had a sensitivity of 100% for septic cases and of 45.5% in cases of increased abrasion and aseptic foreign-body reactions. However, reliable differentiation between abrasion-induced and bacterial-caused inflammation was not possible using FDG-PET. |
3 |
| 95. Basu S, Kwee TC, Saboury B, et al. FDG PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined (111)In-labeled leukocyte/(99m)Tc-sulfur colloid bone marrow imaging in 88 prostheses. Clin Nucl Med. 39(7):609-15, 2014 Jul. |
Observational-Dx |
134 hip and 87 knee prostheses |
To assess and compare the value of FDG PET with combined In-labeled leukocyte/Tc-sulfur colloid bone marrow (WBC/BM) imaging for diagnosing infection in hip and knee prostheses. |
The initial analysis of data from the WBC/BM images demonstrated somewhat suboptimal results compared with those of FDG PET scans on 88 patients. In addition, some patients were not willing to undergo both procedures and therefore participate in this study. Therefore, a decision was made to eliminate WBC/BM imaging from the procedures for the remainder of this research study. This decision was reached partly because of the significant radiation dose delivered from labeled WBC and safety issues related to preparing these labeled cells. Final diagnosis was based on microbiological examinations of the surgical specimens in 125 prostheses and joint aspirations combined with the clinical follow-up of 6 months or more in 86 prostheses. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG PET in hip prostheses were 81.8%, 93.1%, 79.4%, and 94.0%, respectively, and in knee prostheses were 94.7%, 88.2%, 69.2%, and 98.4%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of WBC/BM imaging in hip prostheses were 38.5%, 95.7%, 71.4%, and 84.6%, respectively, and in knee prostheses were 33.3%, 88.5%, 25.0%, and 92.0%, respectively. In those cases that underwent both FDG PET and WBC/BM imaging, there was a trend (P = 0.0625) toward a higher sensitivity for FDG PET in hip prostheses, whereas other comparisons did not show any significant differences between the 2 imaging modalities. |
2 |
| 96. Love C, Marwin SE, Tomas MB, et al. Diagnosing infection in the failed joint replacement: a comparison of coincidence detection18F-FDG and 111In-labeled leukocyte/99mTc-sulfur colloid marrow imaging. J Nucl Med. 2004;45(11):1864-1871. |
Observational-Dx |
59 patients |
To investigate FDG imaging, using a coincidence detection system, for diagnosing prosthetic joint infection and to compare it with combined In-111-labeled leukocyte/Tc-99m-sulfur colloid marrow imaging in patients with failed lower extremity joint replacements. |
25 (42%) prostheses, 14 hip and 11 knee, were infected. The sensitivity, specificity, and accuracy of FDG, by criterion, were as follows: criterion 1: 100%, 9%, 47%; criterion 2: 96%, 35%, 61%; criterion 3: 52%, 44%, 47%; criterion 4: 36%, 97%, 71%. The sensitivity, specificity, and accuracy of labeled leukocyte/marrow imaging were 100%, 91%, and 95%, respectively. WBC/marrow imaging, which was more accurate than any of the FDG criteria for all prostheses, as well as for hips and knees separately, was significantly more sensitive than criterion 3 (P<0.001) and criterion 4 (P<0.001) and was significantly more specific than criterion 1 (P<0.001), criterion 2 (P<0.001), and criterion 3 (P<0.001). |
3 |
| 97. Choe H, Inaba Y, Kobayashi N, et al. Use of 18F-fluoride PET to determine the appropriate tissue sampling region for improved sensitivity of tissue examinations in cases of suspected periprosthetic infection after total hip arthroplasty. Acta Orthop. 2011;82(4):427-432. |
Observational-Dx |
23 THA patients (23 hips) and 17 uninfected THA patients (23 hips; control group) |
To determine whether the results of tissue examinations in THA patients are affected by the sampling location, classified as major, minor, or no-uptake sides in terms of F-18 fluoride uptake. |
17 revision patients showed major uptake and all were diagnosed as having septic loosening from intraoperative tissue results. Minor uptake was observed in the other 6 revision patients and all were diagnosed as having aseptic loosening. Apart from 3 cases that showed minor uptake regions, control subjects showed no uptake. In the revision group, the sensitivities of histopathology, microbiological culture, real-time polymerase chain reaction (PCR) separately and also in combination were 0.78, 0.58, 0.96, and 0.96, respectively, on the major F-18 fluoride uptake sides, 0.0, 0.0, 0.1, and 0.1 on the minor-uptake sides, and 0, 0, 0.18, and 0.18 on the no-uptake sides. |
3 |
| 98. Kobayashi N, Inaba Y, Choe H, et al. Use of F-18 fluoride PET to differentiate septic from aseptic loosening in total hip arthroplasty patients. Clin Nucl Med. 36(11):e156-61, 2011 Nov. |
Observational-Dx |
65 joints |
FDG-PET was used to evaluate THA cases with stable, septic or septic loosened implants to assess the possibility of differentiating these clinical settings using a novel uptake-type classification approach. |
There were significant differences found between the SUVmax values for the aseptic and septic loosening THA cases. In the diagnosis of infection with type 3 pattern, the sensitivity and specificity were measured at 0.95 and 0.98 for all cases, and 0.95 and 0.88 for surgically treated cases, respectively. |
3 |
| 99. Kumar R, Kumar R, Kumar V, Malhotra R. Comparative analysis of dual-phase 18F-fluoride PET/CT and three phase bone scintigraphy in the evaluation of septic (or painful) hip prostheses: A prospective study. J Orthop Sci. 21(2):205-10, 2016 Mar. |
Observational-Dx |
57 hip components in 45 patients |
To establish the clinical utility of dual phase 18F-fluoride PET/CT (DPFP) in diagnosing implant loosening, differentiation between septic and aseptic loosening and to compare the diagnostic accuracy of DPFP and three-phase bone scan (TPBS). |
Out of twelve non-painful hips, DPFP correctly identified no loosening in 11 hips while TPBS detected in 10 hips. In the remaining 45 hips with radiological proven loosening to rule out sepsis, DPFP had a sensitivity, specificity, PPV, NPV and accuracy of 75%, 97%, 92%, 88% and 88% respectively while TPBS revealed 81%, 86%, 76%, 89% and 82% respectively. DPFP had shown a higher specificity and PPV as compared to the TPBS in the evaluation of painful hip prostheses. |
1 |
| 100. Kumar R, Kumar R, Kumar V, Malhotra R. Potential clinical implication of (18) F-FDG PET/CT in diagnosis of periprosthetic infection and its comparison with (18) F-Fluoride PET/CT. J Med Imaging Radiat Oncol. 60(3):315-22, 2016 Jun. |
Observational-Dx |
42 patients |
To assess and compare the diagnostic accuracy of (18) F- flouro-deoxyglucose positron emission tomography/computed tomography ((18) F-FDG PET/CT) with (18) F-fluoride PET/CT for diagnosis of infection in the painful hip prosthesis. |
The sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV) and accuracy of (18) F-FDG PET/CT were 93.7%, 92.3%, 88.2%, 96% and 92.8% respectively. The sensitivity, specificity, PPV, NPV and accuracy of (18) F-fluoride PET/CT were 75%, 96.1%, 92.3%, 86% and 88.1% respectively. |
2 |
| 101. Perez-Prieto D, Hinarejos P, Alier A, et al. Adherence to a reliable PJI diagnostic protocol minimizes unsuspected positive cultures rate. BMC Musculoskelet Disord. 22(1):653, 2021 Aug 02. |
Observational-Dx |
133 patients |
To evaluate the incidence of unsuspected PJI when prosthetic revisions are thoroughly evaluated by PJI dedicated orthopedic surgeon before surgery. |
Based on the PIF criteria, there were 15 infections among the revisions in group 1 and 18 PJI in group 2 (p > 0.05). The most interesting finding was that there were 7 patients with unsuspected positive cultures in group 1. That represents 11% of all revisions. No patient in group 2 was found with unsuspected positive cultures (p < 0.001). |
3 |
| 102. Carli AV, Abdelbary H, Ahmadzai N, et al. Diagnostic Accuracy of Serum, Synovial, and Tissue Testing for Chronic Periprosthetic Joint Infection After Hip and Knee Replacements: A Systematic Review. J Bone Joint Surg Am 2019;101:635-49. |
Review/Other-Dx |
203 studies |
To compare the diagnostic accuracy of serum, synovial, and tissue-based tests for chronic periprosthetic joint infection (PJI). |
Laboratory-based synovial alpha-defensin tests and leukocyte esterase reagent (LER) strips (2+) had the best performance, followed by white blood-cell (WBC) count, measurement of synovial C-reactive protein (CRP) level, measurement of the polymorphonuclear neutrophil percentage (PMN%), and the alpha-defensin lateral flow test kit (Youden index ranging from 0.78 to 0.94). Tissue-based tests and 3 serum tests (measurement of interleukin-6 [IL-6] level, CRP level, and erythrocyte sedimentation rate [ESR]) had a Youden index between 0.61 to 0.75 but exhibited poorer performance compared with the synovial tests mentioned above. |
4 |
| 103. Li R, Li X, Ni M, Zheng QY, Zhang GQ, Chen JY. Anatomic Landmark-Guided Hip Aspiration in the Diagnosis of Periprosthetic Joint Infection. Orthopedics. 44(1):e85-e90, 2021 Jan 01. |
Observational-Dx |
186 consecutive hip aspirations |
To evaluate the results of simply using anatomic landmarks for aspiration and detecting PJI without the use of any complicated technologies. |
The overall aspiration failure rate was 3.8% (7 of 186). No obvious complications related to aspiration were observed. The saline lavage and reaspiration rate was 45.3% (81 of 179) due to "dry taps." The sensitivity, specificity, positive predictive value, and negative predictive value of the remaining 169 patients with definite diagnoses were 0.781 (95% CI, 0.678-0.860), 0.939 (95% CI, 0.857-0.977), 0.931 (95% CI, 0.841-0.975), and 0.802 (95% CI, 0.706-0.874), respectively. |
3 |
| 104. Randelli F, Brioschi M, Randelli P, Ambrogi F, Sdao S, Aliprandi A. Fluoroscopy- vs ultrasound-guided aspiration techniques in the management of periprosthetic joint infection: which is the best?. Radiol Med (Torino). 123(1):28-35, 2018 Jan. |
Observational-Dx |
49 patients |
To determine whether (1) the benefits in terms of sensitivity and specificity and (2) the costs were comparable between fluoroscopy- and ultrasound-guided joint aspirations in a suspicious of hip PJI. |
(1) Ultrasound-guided aspiration revealed valid sensitivity (89% vs 60%) and specificity (94% vs 81%) in comparison with fluoroscopic-guided aspiration. (2) The cost analysis was also in favor of ultrasound-guided aspiration (125.30€) than fluoroscopic-guided aspiration (343.58€). |
3 |
| 105. Tomas X, Bori G, Garcia S, et al. Accuracy of CT-guided joint aspiration in patients with suspected infection status post-total hip arthroplasty. Skeletal Radiol. 2011;40:57-64. |
Observational-Dx |
63 patients |
To determine the accuracy of guided CT aspiration in the detection of septic hip prosthesis before surgery. No intravenous contrast was administered. |
All patients underwent revision surgery and infection was finally diagnosed in 33 patients. Statistical comparative analysis was performed comparing CT aspiration and surgical findings (95% CI; level of significance at P=0.05 2-sided) with 70% sensitivity, 100% specificity, 84% accuracy, 100% PPV, and 75% NPV. Using Fisher's exact test, the presence of periprosthetic fluid collections (P=0.001), prosthetic acetabular malposition (P=0.025) and aspirated fluid volume (P=0.009) were significantly higher in infected than in non-infected prostheses, whereas HO was not (P=0.429). |
2 |
| 106. American Academy of Orthopaedic Surgeons. Diagnosis and Prevention of Periprosthetic Joint Infections. Clinical Practice Guideline on the Diagnosis and Prevention of Periprosthetic Joint Infections. Available at: https://www.aaos.org/quality/quality-programs/tumor-infection-and-military-medicine-programs/diagnosis--prevention-of-periprosthetic-joint-infections/. |
Review/Other-Dx |
N/A |
To synthesize published research with the aim of providing a transparent and robust summary of the research findings for a particular orthopaedic disease topic. |
No results stated in abstract. |
4 |
| 107. Plodkowski AJ, Hayter CL, Miller TT, Nguyen JT, Potter HG. Lamellated hyperintense synovitis: potential MR imaging sign of an infected knee arthroplasty. Radiology. 2013;266(1):256-260. |
Observational-Dx |
28 patients with proved infected total knee arthroplasty and 28 patients with noninfected arthroplasty |
To determine the sensitivity and specificity of lamellated hyperintense synovitis for infection following knee arthroplasty and to determine the inter- and intraobserver variability of this sign at MRI. |
The sensitivity of lamellated hyperintense synovitis for infection was 0.86–0.92 (95% CI: 0.75, 0.97) and the specificity was 0.85–0.87 (95% CI: 0.74, 0.94). There was almost perfect interobserver agreement (kappa = 0.82; 95% CI: 0.72, 0.93; P<0.001) and intraobserver agreement (for reader 1, kappa = 0.89 [95% CI: 0.78, 1.00; P<0.001] and for reader 2, kappa = 0.89 [95% CI: 0.77, 1.00; P<0.001]) in the classification of the synovial pattern. |
2 |
| 108. Albano D, Messina C, Zagra L, et al. Failed Total Hip Arthroplasty: Diagnostic Performance of Conventional MRI Features and Locoregional Lymphadenopathy to Identify Infected Implants. J Magn Reson Imaging. 53(1):201-210, 2021 01. |
Observational-Dx |
119 patients |
To determine the diagnostic performance of conventional MRI features and of new lymph nodal indices to identify infection in patients with failed THA. |
RNS, RNN, DNS, and DNN indices were significantly different (P = 0.000) between infected and noninfected THA, with accuracies ranging from 84.8% (RNS) and 93.1% (RNN). All other MRI features were significantly more prevalent in infected THA (P = 0.002), except bone destruction, periarticular soft-tissue mass, and fibrous membrane (P = 0.031). Sensitivities ranged from 7.9% (soft-tissue mass) to 76.3% (effusion/bone edema), specificity from 45.7% (bone destruction) to 97.5% (synovitis/lamellated synovitis), accuracy from 49.6% (bone destruction) to 81.5% (synovitis), OR from 0.261 (soft-tissue mass) to 35.550 (synovitis). |
2 |
| 109. Galley J, Sutter R, Stern C, Filli L, Rahm S, Pfirrmann CWA. Diagnosis of Periprosthetic Hip Joint Infection Using MRI with Metal Artifact Reduction at 1.5 T. Radiology. 296(1):98-108, 2020 07. |
Observational-Dx |
140 patients |
To evaluate findings of PJI after THA and to determine the diagnostic performance of 1.5-T MRI with metal artifact reduction. |
Forty patients (mean age, 69 years ± 11 [standard deviation]; 26 men) in the infection group and 100 patients (mean age, 67 years ± 11; 42 men) in the control group were evaluated. Periosteal reaction, capsule edema, and intramuscular edema differed between the two groups (P < .001 for each finding). Periosteal reaction was found in 31 of 40 patients with infection and 10 of 100 participants in the control group (sensitivity, 78%; specificity, 90%; accuracy, 86%); capsule edema was found in 33 of 40 (infection group) and five of 100 (control group) (sensitivity, 83%; specificity, 95%; accuracy, 91%); and intramuscular edema was found in 38 of 40 (infection group) and 14 of 100 (control group) (sensitivity, 95%; specificity, 86%; accuracy, 89%). Interobserver agreement was almost perfect, with ? values between 0.88 and 0.92. No difference between the two groups was found regarding the presence of osteolysis (infection group, 23 of 40; control group, 60 of 100), bone marrow edema (39 of 40 vs 87 of 100), effusion (20 of 40 vs 26 of 100), abductor tendon lesion (22 of 40 vs 62 of 100), or bursitis (14 of 40 vs 34 of 100) (P > .05 for each finding). |
2 |
| 110. Gao Z, Jin Y, Chen X, et al. Diagnostic Value of MRI Lamellated Hyperintense Synovitis in Periprosthetic Infection of Hip. Orthop Surg 2020;12:1941-46. |
Observational-Dx |
50 patients |
To investigate the correlation between magnetic resonance imaging (MRI) lamellated hyperintense synovitis and periprosthetic infection of hip arthroplasty and estimate its value in the diagnosis of infection after hip replacement. |
The incidence of lamellated hyperintense synovitis was 76%-88% in the experimental group and 8%-16% in the control group. The sensitivity of lamellated hyperintense synovitis for infection was 0.80-0.88 (95% confidence interval [CI]:0.59 - 0.97), the specificity was 0.84~0.92 (95% CI: 0.64 -0.99), the positive predictive value 0.83-0.92 (95% CI: 0.67 - 0.98), the negative predictive value 0.81 - 0.88 (95% CI: 0.65 - 0.96). The agreement between two readers was substantial (Kappa = 0.76, 95% CI: 0.58 - 0.94, P < 0.05). There were moderate inter-observer agreements for both readers, reader 1 (Kappa = 0.48, 95%CI: 0.23 - 0.72, P < 0.05) and reader 2 (Kappa = 0.44,95% CI: 0.19 - 0.69, P < 0.05). |
2 |
| 111. Schwaiger BJ, Gassert FT, Suren C, et al. Diagnostic accuracy of MRI with metal artifact reduction for the detection of periprosthetic joint infection and aseptic loosening of total hip arthroplasty. Eur J Radiol. 131:109253, 2020 Oct. |
Observational-Dx |
41 patients |
To evaluate imaging characteristics obtained from magnetic resonance imaging (MRI) with metal artifact reduction (MAR) to differentiate between periprosthetic joint infection (PJI), aseptic loosening and cases without these pathologies after total hip arthroplasty (THA). |
Findings at the acetabular cup were specific for the presence of either PJI or aseptic loosening (specificity>0.765 for all), while findings at the stem were sensitive (sensitivity>0.824 for all except periostitis). To differentiate PJI versus aseptic loosening, soft tissue edema (sensitivity, 0.867/specificity>0.733), abnormalities at both, acetabular and femoral components (0.667/0.933-1.000) and enlarged lymph nodes (0.800/0.867) were accurate. |
2 |
| 112. Aliprandi A, Sconfienza LM, Randelli F, Bandirali M, Di Leo G, Sardanelli F. Magnetic resonance imaging of painful total hip replacement: detection and characterisation of periprosthetic fluid collection and interobserver reproducibility. Radiol Med. 2012;117:85-95. |
Observational-Dx |
19 patients |
To demonstrate the diagnostic value of MRI when measuring and characterizing periprosthetic fluid collections in patients with painful hip prosthesis and to provide an estimation of interobserver reproducibility. |
A total of 26 MRI studies were carried out (3 patients underwent 2 and 2 patients underwent 3 MRI examinations). Both readers detected soft tissue oedema (13/26, 50%) or fluid collection (21/26, 81%) and characterized the fluid as serous (9/21, 43%), purulent (8/21, 38%) or haematic (4/21, 19%). The collection involved skin/subcutaneous tissues (16/21, 76%), deep soft tissues (19/21, 91%) or the implant (12/21, 57%). For all evaluations, interobserver agreement was complete (=1). No significant differences were found between the measurements of the collections (P>0.258). |
3 |
| 113. Weybright PN, Jacobson JA, Murry KH, et al. Limited effectiveness of sonography in revealing hip joint effusion: preliminary results in 21 adult patients with native and postoperative hips. AJR Am J Roentgenol 2003;181:215-8. |
Observational-Dx |
21 patients |
To determine the effectiveness of sonography in the detection of hip joint effusions in both native and postoperative adult hips using arthrocentesis as a gold standard. |
Joint effusion was seen on diagnostic arthrocentesis in 10 (48%) of the 21 patients. Seven of the 21 patients had native hips and 14 had prior hip surgery. Retrospectively, no significant difference was found with regard to the size of the anterior recess distention (p = 0.34) or echogenicity (p = 0.2) when comparing the patients with and without joint effusion. |
3 |
| 114. van Holsbeeck MT, Eyler WR, Sherman LS, et al. Detection of infection in loosened hip prostheses: efficacy of sonography. AJR Am J Roentgenol 1994;163:381-4. |
Observational-Dx |
33 patients |
To determine the efficacy of sonography in the detection of infection in loosened hip prostheses. |
On sonograms, the normal pseudocapsule is adherent to the proximal part of the anterior femoral cortex, and the capsule-to-bone distance is <3.2 mm (average, 2.6 mm). No hips with a capsule-to-bone distance <3.2 mm were infected. Sonograms in the 6 patients with infection showed marked intra-articular effusion with a mean capsule-to-bone distance of 10.2 mm. 5/6 had extracapsular fluid collections. 2 patients with hip dislocations and 4 with aseptic loosening of the prosthesis had capsular distension on sonograms and cultures of aspirated material that showed no growth. |
3 |
| 115. Joseph TN, Mujtaba M, Chen AL, et al. Efficacy of combined technetium-99m sulfur colloid/indium-111 leukocyte scans to detect infected total hip and knee arthroplasties. J Arthroplasty. 2001;16(6):753-758. |
Observational-Dx |
58 patients |
To investigate the reliability of combined In-111 leukocyte/Tc-99m sulfur colloid scans, with and without the addition of blood pooling and blood flow studies, in the diagnosis of infected total joint arthroplasty. |
Results for imaging alone included 100% specificity, 46% sensitivity, 100% PPV, 84% NPV, and 88% accuracy. Inclusion of blood pooling and flow phase data improved results to 66% sensitivity, 89% NPV, and 90% accuracy, with reductions in specificity (98%) and PPV (91%). Routine use of these radionuclide scans is not supported by these data. |
3 |
| 116. Palestro CJ, Kim CK, Swyer AJ, Capozzi JD, Solomon RW, Goldsmith SJ. Total-hip arthroplasty: periprosthetic indium-111-labeled leukocyte activity and complementary technetium-99m-sulfur colloid imaging in suspected infection. J Nucl Med. 1990;31:1950-5. |
Observational-Dx |
72 patients with 92 (68 primary, 24 revision) cemented THAs |
To report the patterns of periprosthetic labeled leukocyte activity in 92 cemented total-hip arthroplasties, as well as the results of combined In-111-labeled leukocyte and Tc-99m sulfur colloid imaging of 50 of these arthroplasties. |
Though present in all 23 infected arthroplasties, periprosthetic activity was also present in 77% of uninfected arthroplasties, and was greater than the contralateral zone 51% of the time. When analyzed by zone, head zone activity was the best criterion for infection (87% sensitivity, 94% specificity, 92% accuracy). 50 of the arthroplasties were studied with combined labeled leukocyte/sulfur colloid imaging. Using incongruence of images as the criterion for infection, the sensitivity, specificity, and accuracy of the study were 100%, 97%, and 98%, respectively. While variable periprosthetic activity makes labeled leukocyte imaging alone unreliable for diagnosing hip arthroplasty infection, the addition of sulfur colloid imaging results in a highly accurate diagnostic procedure. |
3 |
| 117. Temmerman OP, Raijmakers PG, Berkhof J, et al. Diagnostic accuracy and interobserver variability of plain radiography, subtraction arthrography, nuclear arthrography, and bone scintigraphy in the assessment of aseptic femoral component loosening. Arch Orthop Trauma Surg. 2006;126:316-23. |
Observational-Dx |
78 patients |
To evaluate the diagnostic accuracy and interobserver reliability of plain radiography, subtraction arthrography, nuclear arthrography, and bone scintigraphy in patients (mean age 70 years, range 29-88 years) referred for evaluation of their femoral hip prostheses. |
Overall, plain radiography had a sensitivity and specificity of 81% and 74%, respectively. Subtraction arthrography had a sensitivity of 47% and a specificity of 78%. Nuclear arthrography had a sensitivity of 69% and a specificity of 76%, and bone scintigraphy had a sensitivity of 88% with a specificity of 50%. |
3 |
| 118. Temmerman OP, Raijmakers PG, David EF, et al. A comparison of radiographic and scintigraphic techniques to assess aseptic loosening of the acetabular component in a total hip replacement. J Bone Joint Surg Am. 2004;86-A:2456-63. |
Observational-Dx |
86 patients |
To evaluate the sensitivity, specificity, and interobserver reliability of plain radiography, subtraction arthrography, nuclear arthrography, and bone scintigraphy in patients suspected of having aseptic loosening of the acetabular component. |
Plain radiography had a sensitivity of 85% (95% CI, 71 to 94) and a specificity of 85% (95% CI, 66 to 96) in detecting aseptic loosening of the acetabular component, but it had only fair interobserver variability (ICC, 0.37). For subtraction arthrography, the sensitivity was 72% (95% CI, 57 to 84), the specificity was 70% (95% CI, 50 to 86), and there was good interobserver variability (ICC, 0.71). For nuclear arthrography, the sensitivity was 57% (95% CI, 41 to 71), the specificity was 67% (95% CI, 46 to 84), and there was fair interobserver variability (ICC, 0.24). For bone scintigraphy, the sensitivity was 83% (95% CI, 69 to 92), the specificity was 67% (95% CI, 46 to 84), and there was moderate interobserver variability (ICC, 0.43). |
3 |
| 119. Backer HC, Steurer-Dober I, Beck M, et al. Magnetic resonance imaging (MRI) versus single photon emission computed tomography (SPECT/CT) in painful total hip arthroplasty: a comparative multi-institutional analysis. Br J Radiol. 93(1105):20190738, 2020 Jan. |
Observational-Dx |
35 consecutive patients with 37-painful hip arthroplasties |
To investigate the value of MRI in comparison to single photon emission computed tomography (SPECT)/CT in patients with painful hip arthroplasties. |
Loosening was observed in 13/37 arthroplasties (6 shaft only, 6 cup only, 1 combined). Sensitivity, specificity, positive predictive value and negative predictive value for loosening of MRI were 86%/88%/60%/100% and of SPECT/CT 93%/97%/90%/100%, respectively. MRI and SPECT/CT diagnosed infection correctly in two of three patients and fractures in two patients, which were missed by X-ray. MRI detected soft tissue abnormalities in 21 patients (6 bursitis, 14 tendon lesions, 1 pseudotumor), of which only 1 tendon abnormality was accurately detected with SPECT/CT. All 5 arthroplasties with polyethylene wear were correctly diagnosed clinically and with both imaging modalities. MRI and SPECT/CT were judged as not helpful in 0/0%, as helpful in 16%/49% and essential in 84%/51%. |
1 |
| 120. Berber R, Henckel J, Khoo M, et al. Clinical Usefulness of SPECT-CT in Patients with an Unexplained Pain in Metal on Metal (MOM) Total Hip Arthroplasty. J Arthroplasty. 30(4):687-94, 2015 Apr. |
Observational-Dx |
19 prosthetic MOM hips in 15 subjects |
To evaluate the clinical usefulness of SPECT-CT in unexplained painful MOM hip arthroplasty. |
SPECT-CT changed the management decision in 13 (68%) subjects, Chi-Square=5.49, P=0.24. In 6 subjects (32%) pain remained unexplained however the result reassured the surgeon to continue with non-operative management. |
3 |
| 121. Blum A, Gondim-Teixeira P, Gabiache E, et al. Developments in imaging methods used in hip arthroplasty: A diagnostic algorithm. Diagn Interv Imaging. 97(7-8):735-47, 2016 Jul-Aug. |
Review/Other-Dx |
N/A |
To identify recent studies comparing the performances of various imaging techniques for diagnosing hip prosthesis-related complications. |
No results stated in the abstract. |
4 |
| 122. Kwak HS, Yoo JJ, Lee YK, Koo KH, Yoon KS, Kim HJ. The result of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a polyethylene liner. Clin. orthop. surg.. 7(1):46-53, 2015 Mar. |
Review/Other-Tx |
27 patients |
To evaluate the clinical characteristics and the survival rate of revision THA performed in patients with metallosis following a catastrophic failure of a PE liner. |
The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively. |
4 |
| 123. Kirkham JR, Petscavage JM, Richardson ML. Metallosis: CT findings in a total hip arthroplasty. Radiol Case Rep 2010;5:410. |
Review/Other-Dx |
1 patient |
To report a case of a 50-year-old man with extensive metallosis 20 years after right total hip arthroplasty. |
CT demonstrated osteolysis and radiodense debris surrounding the right hip joint. |
4 |
| 124. Gillet R, Teixeira P, Bonarelli C, et al. Comparison of radiographs, tomosynthesis and CT with metal artifact reduction for the detection of hip prosthetic loosening. Eur Radiol. 29(3):1258-1266, 2019 Mar. |
Observational-Dx |
49 patients |
To evaluate the diagnostic performance of digital tomosynthesis (DTS) for the diagnosis of hip prosthesis loosening (PL) compared with conventional radiographs and CT with metal artifact reduction (CT-MAR). |
There were 21 cases of PL, 9 unilateral and 12 bilateral. For both the acetabular and femoral sides, DTS had a specificity for PL detection similar to that of conventional radiographs and CT-MAR (98.5-100%, 96.9%-100% and 96.9-95.4% respectively for both readers) and a sensitivity similar to conventional radiographs (39.9-45.4% versus 33.3-51.5% for both readers) but lower than CT-MAR (84.85% for both readers). The interobserver agreement was 0.84 for CT-MAR, 0.53 for DTS and 0.39 for conventional radiographs. |
2 |
| 125. Puri L, Wixson RL, Stern SH, Kohli J, Hendrix RW, Stulberg SD. Use of helical computed tomography for the assessment of acetabular osteolysis after total hip arthroplasty. J Bone Joint Surg Am. 2002;84-A:609-14. |
Observational-Dx |
40 patients (50 hips) |
To determine the efficacy and potential role of high-resolution helical (or spiral) CT with metal-artifact minimization in the early detection of osteolysis of the pelvis and to use the method to determine if there was a relationship between the extent of osteolysis and the amount of polyethylene wear. |
Acetabular lysis was identified on the radiographs of 16 hips and on the CT scans of 26 hips. Radiographs underestimated the extent of the lysis in 13/16 hips. There was no correlation (r = 0.036) between linear wear and the measured volume of bone loss, with the numbers available. On the basis of the amount of lysis seen on the CT scans, 1 patient underwent a revision procedure. |
3 |
| 126. Walde TA, Weiland DE, Leung SB, et al. Comparison of CT, MRI, and radiographs in assessing pelvic osteolysis: a cadaveric study. Clin Orthop Relat Res. 2005:138-44. |
Observational-Dx |
3 complete pelves |
To compare the accuracy of radiography, CT, and MRI in assessing periacetabular osteolytic lesions. |
The sensitivity for detecting lesions was 51.7% for radiography, 74.7% for CT, and 95.4% for MRI. For all 3 techniques, sensitivity increased as lesion size increased. MRI emerged as the most effective tool for detecting small periacetabular osteolytic lesions (=3 cm). For lesions >3 cm, which are of more concern clinically, CT and MRI were effective in identifying lesions with detection rates >80%. For radiography and CT, lesion detection was dependent on lesion location, whereas MRI had consistently good sensitivity in all lesion locations. Although the mean volumetric errors for CT and MRI (0.3 cm and 0.8 cm) were small compared with mean lesion volume (6.1 cm), CT was more accurate than MRI at measuring lesion volume, with a lower mean absolute error. |
3 |
| 127. Duffy PJ, Masri BA, Garbuz DS, Duncan CP. Evaluation of patients with pain following total hip replacement. J Bone Joint Surg Am 2005;87:2566-75. |
Review/Other-Dx |
na |
No abstract available. |
No abstract available. |
4 |
| 128. Braunstein EM, Cardinal E, Buckwalter KA, Capello W. Bupivicaine arthrography of the post-arthroplasty hip. Skeletal Radiol 1995;24:519-21. |
Observational-Dx |
12 |
To determine if the addition of bupivicaine during arthrography provides additional information useful in management decisions regarding the necessity of revision arthroplasty. |
In 12 surgically proven cases, complete relief of pain after bupivicaine injection correctly identified an intracapsular source of pain in 10, with only 1 false-positive and 1 false-negative. |
3 |
| 129. Maus TP, Berquist TH, Bender CE, Rand JA. Arthrographic study of painful total hip arthroplasty: refined criteria. Radiology. 1987;162:721-7. |
Observational-Dx |
170 patients 178 arthrograms |
To refine the criteria for the diagnosis of loosening and infection of the joint. The authors also attempted better documentation of the presence of bursal filling and its role in evaluation of loosening and infection. |
97 arthroplasties that were surgically evaluated form the basis of this report. With the refined criteria, subtraction arthrography had a sensitivity of 96% and specificity of 92% for demonstrating loosening of the femoral component and a sensitivity of 97% and a specificity of 68% for demonstrating loosening of the acetabular component. Pseudocapsule size and the presence of bursae were important factors influencing arthrographic interpretation. Arthrographic findings of pseudocapsule irregularity and the presence of nonbursal cavities were suggestive of infection but were not sensitive or specific. Laboratory evaluation of aspirated material was a more reliable predictor of infection, although its sensitivity was only 71%. |
4 |
| 130. Crawford RW, Ellis AM, Gie GA, Ling RS. Intra-articular local anaesthesia for pain after hip arthroplasty. J Bone Joint Surg Br 1997;79:796-800. |
Review/Other-Dx |
15 patients |
To report the results of the use of intra-articular local anaesthesia to clarify the source of pain after total hip arthroplasty. |
Fourteen had pain relief and 13 of them were subsequently found to have loosening of one or both components. The relief of pain after total hip arthroplasty by intra-articular injection of bupivicaine indicates that a satisfactory result is probable after revision surgery with refixation of the components. |
4 |
| 131. Hayter CL, Koff MF, Potter HG. Magnetic resonance imaging of the postoperative hip. J Magn Reson Imaging. 2012;35(5):1013-1025. |
Review/Other-Dx |
N/A |
To discuss the technical aspects of MRI around metallic implants as well as the appearance of potential complications following hip arthroplasty, including osteolysis, wear-induced synovitis, infection, hemarthrosis, fracture, loosening, component displacement, HO, tendinopathy, and neurovascular impingement. The specific complication of metal hypersensitivity following MoM prostheses is reviewed. |
MRI is the most accurate imaging modality in the assessment of periprosthetic osteolysis and wear-induced synovitis, and can also assess regional tendons and neurovascular structures. |
4 |
| 132. Burge AJ, Konin GP, Berkowitz JL, Lin B, Koff MF, Potter HG. What is the Diagnostic Accuracy of MRI for Component Loosening in THA? Clin Orthop Relat Res 2019;477:2085-94. |
Observational-Dx |
212 patients |
(1) Is assessing implant integration using MRI (with multiacquisition variable resonance image combination, [MAVRIC]) repeatable between readers? (2) What is the sensitivity and specificity of MRI with MAVRIC to evaluate component loosening, using intraoperative assessment as a gold standard? (3) How does the sensitivity and specificity of MRI with MAVRIC for surgically confirmed component loosening compare with those of radiographs? |
Gwet's agreement coefficients (AC) were used to describe interobserver agreement; these are similar to Cohen's kappa but are more resistant to certain paradoxes, such as unexpectedly low values in the setting of very high or low trait prevalence, or good agreement between readers on marginal counts. Almost perfect interobserver agreement (AC2 = 0.81-1.0) was demonstrated for all acetabular zones and all femoral Gruen zones on MRI, while perfect (AC1 = 1.0) agreement was demonstrated for the overall assessment of acetabular component loosening and near perfect agreement was shown for the assessment of femoral component loosening (AC1 = 0.98). MRI demonstrated a sensitivity and specificity of 83% (95% CI, 65-96) and 98% (95% CI, 97-100), respectively, for acetabular component loosening and 75% (95% CI, 55-94) and 100% (95% CI, 100-100), respectively, for femoral component loosening. Radiographs demonstrated a sensitivity and specificity of 26% (95% CI, 12-47) and 100% (95% CI, 96-100), respectively, for acetabular component loosening and 20% (95% CI, 9-47) and 100% (95% CI, 100-100), respectively, for femoral component loosening. |
2 |
| 133. Potter HG, Nestor BJ, Sofka CM, Ho ST, Peters LE, Salvati EA. Magnetic resonance imaging after total hip arthroplasty: evaluation of periprosthetic soft tissue. J Bone Joint Surg Am. 2004;86-A(9):1947-1954. |
Review/Other-Dx |
28 hips in 27 patients |
To investigate the use of modified MRI techniques involving commercially available software to visualize periprosthetic soft tissues, to define the bone-implant interface, and to detect the location and extent of osteolysis. |
MRI demonstrated the bone-implant interface and the surrounding soft-tissue envelope in all hips. Radiographs consistently underestimated the extent and location of acetabular osteolysis when compared with MRI. MRI also disclosed radiographically occult extraosseous soft-tissue deposits that were similar in signal intensity to areas of osteolysis, demonstrated the relationship of these deposits to adjacent neurovascular structures, and allowed further visualization of hypertrophic synovial deposits that accompanied the bone resorption in 25/28 hips. |
4 |
| 134. Robinson E, Henckel J, Sabah S, Satchithananda K, Skinner J, Hart A. Cross-sectional imaging of metal-on-metal hip arthroplasties. Can we substitute MARS MRI with CT? Acta Orthop 2014;85:577-84. |
Observational-Dx |
50 MOM-HA patients |
To determine whether CT is a suitable substitute for MARS MRI in evaluation of the painful MOM-HA. |
Pseudotumor was diagnosed in 25 of 50 hips by MARS MRI and in 11 of 50 by CT. Pseudotumors were classified as type 1 (n = 2), type 2A (n = 17), type 2B (n = 4), and type 3 (n = 2) by MARS MRI. CT did not permit pseudotumor classification. The sensitivity of CT for diagnosis of pseudotumor was 44% (95% CI: 25–65). CT had “slight” agreement with MARS MRI for quantification of muscle atrophy (? = 0.23, CI: 0.16–0.29; p < 0.01). Osteolysis was identified in 15 of 50 patients by CT. 4 of these lesions were identified by MARS MRI. |
3 |
| 135. Ovesen O, Riegels-Nielsen P, Lindequist S, et al. The diagnostic value of digital subtraction arthrography and radionuclide bone scan in revision hip arthroplasty. J Arthroplasty 2003;18:735-40. |
Observational-Dx |
56 patients |
To evaluate the diagnostic value of digital subtraction arthrography (DSA) and RBS in a prospective and consecutive study involving cemented total hip arthroplasties undergoing revision surgery. |
Results of each study were compared with intraoperative assessment of the status of components and expressed in terms of sensitivity, specificity, and accuracy. Overall accuracy for the acetabular component by PSR was 66%; by DSA, 93%; by RBS, 46%. Overall accuracy for the femoral component by PSR was 79%; by DSA, 93%; RBS, 50%. |
3 |
| 136. von Knoch M, Barden B, Saxler G, Loer F. The diagnostic value of digital subtraction arthrography and radionuclide arthrography in revision total hip arthroplasty. Biomed Tech (Berl) 2004;49:351-5. |
Observational-Dx |
25 revision hip arthroplasties |
To investigate whether digital subtraction arthrography and radionuclide arthrography provide more information than plain radiographs for preoperative evaluation of total hip arthroplasty. |
Overall accuracy for the acetabular component by plain radiographs was 80%; by digital subtraction arthrography, 88%; by radionuclide arthrography, 68%. Overall accuracy for the femoral component by plain radiographs was 92%; by digital subtraction arthrography, 84%; radionuclide arthrography, 76%. |
3 |
| 137. Kwon YM, Khormaee S, Liow MH, Tsai TY, Freiberg AA, Rubash HE. Asymptomatic Pseudotumors in Patients with Taper Corrosion of a Dual-Taper Modular Femoral Stem: MARS-MRI and Metal Ion Study. Journal of Bone & Joint Surgery - American Volume. 98(20):1735-1740, 2016 Oct 19.J Bone Joint Surg Am. 98(20):1735-1740, 2016 Oct 19. |
Review/Other-Dx |
97 patients |
To determine the prevalence of asymptomatic pseudotumors by utilizing metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) and compare serum metal-ion levels between symptomatic and asymptomatic patients with a dual-taper modular stem total hip replacement. |
The prevalence of pseudotumors as determined with MARS-MRI was 15% in our asymptomatic patients and 36% in the overall cohort. The median serum cobalt level and cobalt/chromium ratio were significantly higher in patients with a pseudotumor than in those without a pseudotumor (8.0 versus 2.0 µg/L [p = 0.004] and 10.3 versus 2.4 µg/L [p = 0.012], respectively). However, there was no significant difference in the serum cobalt level or cobalt/chromium ratio between symptomatic patients with a pseudotumor and asymptomatic patients with a pseudotumor (7.6 versus 6.2 µg/L [p = 0.37] and 8.3 versus 10.6 µg/L [p = 0.46], respectively). The UCLA scores of asymptomatic patients with a pseudotumor were similar to those of patients without a pseudotumor (6.7 versus 6.6). |
4 |
| 138. Kwon YM, Rossi D, MacAuliffe J, Peng Y, Arauz P. Risk Factors Associated With Early Complications of Revision Surgery for Head-Neck Taper Corrosion in Metal-on-Polyethylene Total Hip Arthroplasty. J Arthroplasty. 33(10):3231-3237, 2018 10. |
Review/Other-Tx |
39 patients |
To report early complication rates and outcome, and identifying risk factors associated with complications of revision surgery for head-neck taper corrosion in patients with MoP THA. |
The overall complication rate was 25% and the reoperation rate was 10%. The median serum level of cobalt ions decreased significantly 8.2 µg/L (1.2-56.1 µg/L) pre-revision to 3.1 µg/L (0.2-14.0 µg/L) post-revision (P < .01). High fretting and corrosion grades (Goldberg score = 3) were observed in 82% of retrieved implants. MRI findings of solid lesion(s) with abductor deficiency (P < .01) and intraoperative tissue damage at revision (P = .02) were significantly associated with post-revision complications. |
4 |
| 139. Padgett DE, Su EP, Wright TM, Burge AJ, Potter HG. How Useful Is Magnetic Resonance Imaging in Evaluating Adverse Local Tissue Reaction?. J Arthroplasty. 35(6S):S63-S67, 2020 06. |
Review/Other-Dx |
N/A |
To review MR imaging techniques in patients suspected of having an adverse tissue reaction after hip arthroplasty. |
No results stated in abstract. |
4 |
| 140. Mahajan J, Bonner B, Oganesyan R, Yeo I, Klemt C, Kwon YM. MARS MRI Characteristics of Adverse Local Tissue Reactions in Taper Corrosion of Metal-On-Polyethylene THA Differ From Metal-On-Metal THA. J Arthroplasty. 35(11):3338-3342, 2020 11. |
Review/Other-Dx |
197 patients |
To compare MARS MRI characteristics of ALTR in MoM total hip arthroplasty (THA) with ALTR in MoP THA with modular taper corrosion. |
MARS MRI characteristics of ALTR were significantly different between the MoM and MoP groups (P = .017). The MoP group demonstrated the highest proportion of thick-walled cystic masses type II (56.7% in head-neck taper corrosion MoP and 46.5% in dual taper corrosion MoP vs 28.7% in MoM), whereas the MoM group had the highest proportion of thin-walled cystic masses type I. MoM implants (96.8%) were significantly more likely to have ALTR in multiple locations compared with both MoP groups (P = .001). |
4 |
| 141. Weber MA, Snyder MJ, Workman KK, et al. Comparison of Asymptomatic and Symptomatic Adverse Local Tissue Reaction in Patients With Head-Neck Taper Corrosion. J Arthroplasty. 36(7S):S358-S362, 2021 07. |
Review/Other-Dx |
94 patients |
To compare differences between asymptomatic and symptomatic ALTR in an observational cohort, including presentation, metal ion differences, and metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) findings. |
For patients with confirmed ALTR, 41% were asymptomatic. There was a statistically significant difference in the serum chromium levels between symptomatic and asymptomatic ALTR patients (2.2 µg/L vs 3.1 µg/L, P = .05). There was no statistically significant difference between the serum cobalt levels or MRI findings in these 2 groups. |
4 |
| 142. Koff MF, Esposito C, Shah P, et al. MRI of THA Correlates With Implant Wear and Tissue Reactions: A Cross-sectional Study. Clin Orthop. 477(1):159-174, 2019 01. |
Observational-Dx |
181 patients |
To correlate findings from MRI in patients who have undergone THA with direct assessment of implant wear, corrosion, and fretting from retrieved components; and (2) to distinguish the unique synovial responses on MRI in patients who have undergone THA based on bearing materials. |
Correlations were found between MRI synovial thickness with severity of fretting and corrosion damage of the female head-neck trunnion of femoral stems in modular designs (? = 0.26 [95% confidence interval {CI}, 0.12-0.39]; p = 0.015, n = 185) and ALTR grade and volumetric wear in MoM bearings (? = 0.93 [95% CI, 0.72-0.98]; p < 0.001, n = 10). MRI synovial thickness was highest in patients identified with aseptic lymphocyte-dominated vasculitis-associated lesions and diffuse tissue necrosis. On MRI, MoP hips demonstrated a distinct polymeric synovial response, whereas HRA, MoM, and modular hips more commonly demonstrated ALTR. Hips classified as having a polymeric synovial response on MRI had a greater number of particles present in tissue samples. |
2 |
| 143. Morozov PP, Sana M, McGrory BJ, Farraher SW, Abrahams TG. Comparison of Pre-Revision Magnetic Resonance Imaging and Operative Findings in Mechanically Assisted Crevice Corrosion in Symptomatic Metal-on-Polyethylene Total Hip Arthroplasties. J Arthroplasty. 32(8):2535-2545, 2017 08. |
Observational-Dx |
20 patients |
To examine the correlation between preoperative MARS MRI and surgical findings in a cohort of 20 consecutive patients undergoing revision THA for symptomatic MACC without other associated orthopedic diagnoses. |
MARS MRI complex synovitis, thickened pseudocapsule, and extra-articular fluid extension each strongly correlated with both the soft-tissue damage grade and trunnion damage noted at surgery. Bone marrow edema was also found to strongly correlate with bone necrosis intraoperatively. |
3 |
| 144. Robbins GM, Masri BA, Garbuz DS, Duncan CP. Evaluation of pain in patients with apparently solidly fixed total hip arthroplasty components. J Am Acad Orthop Surg 2002;10:86-94. |
Review/Other-Dx |
N/A |
To discuss the evaluation of the painful hip after a seemingly well-fixed THA. |
No results stated in abstract. |
4 |
| 145. Shemesh SS, Moucha CS, Keswani A, Maher NA, Chen D, Bronson MJ. Trochanteric Bursitis Following Primary Total Hip Arthroplasty: Incidence, Predictors, and Treatment. J Arthroplasty 2018;33:1205-09. |
Review/Other-Tx |
990 primary THAs |
To determine the incidence of TB after primary THA, identify potential risk factors for TB, and examine the utility of different modes of treatment. |
The incidence of TB following primary THA was 5.4% (54/990) for the entire cohort. The incidence did not differ significantly between the PA and DAA (5% vs 6.1%, respectively; P = .47). Charlson comorbidity index and American Society of Anesthesiology did not differ significantly in the TB group. Lumbar spinal stenosis and history of past smoking were significantly more common in patients who developed TB (P = .03, P = .01, respectively), but did not continue to be significant risk factors on multivariate analysis. All patients were treated nonoperatively by the time of final follow-up. Seventy-four percent required a local steroid injection and 30% required treatment with more than one modality. |
4 |
| 146. Bremer AK, Kalberer F, Pfirrmann CW, Dora C. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: comparison between the direct anterior and the transgluteal approaches. J Bone Joint Surg Br 2011;93:886-9. |
Observational-Dx |
50 patients |
To test the hypothesis that, compared with the transgluteal approach, the minimally invasive anterior approach considerably reduced damage to muscle and tendons as evaluated by MRI one year after THR. |
Detachment of the abductor insertion, partial tears and tendonitis of gluteus medius and minimus, the presence of peri-trochanteric bursal fluid and fatty atrophy of gluteus medius and minimus were significantly less pronounced and less frequent when the direct anterior approach was used. There was no significant difference in the findings regarding tensor fascia lata between the two approaches. |
3 |
| 147. Pfirrmann CW, Notzli HP, Dora C, Hodler J, Zanetti M. Abductor tendons and muscles assessed at MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients. Radiology. 2005;235(3):969-976. |
Observational-Dx |
25 asymptomatic patients and 39 symptomatic patients |
To prospectively evaluate MRI findings of abductor tendons and muscles in asymptomatic and symptomatic patients after lateral transgluteal THA. |
Tendon defects were uncommon in asymptomatic patients and significantly more frequent in symptomatic patients: 2 asymptomatic vs 22 symptomatic patients had gluteus minimus defects (P<0.001); 4 asymptomatic vs 24 symptomatic patients, lateral gluteus medius defects (P<0.001); and no asymptomatic vs 7 symptomatic patients, posterior gluteus medius defects (P=0.025). In both patient groups, tendon signal intensity changes were frequent, with the exception of those in the posterior gluteus medius tendon, which demonstrated these changes more frequently in symptomatic patients (in 23 vs 5 asymptomatic patients, P=0.002). Tendon diameter changes were frequent in both groups but significantly (P=0.001 to P=0.009) more frequent in symptomatic patients (all tendon parts). Fatty atrophy was evident in the anterior two-thirds of the gluteus minimus muscle in both groups, without significant differences. In the posterosuperior third of the gluteus minimus muscle, however, differences in fatty atrophy between the 2 groups were significant (P=0.026). Fatty atrophy of the gluteus medius muscle was present in symptomatic patients only, with significant differences among all muscle parts. Bursal fluid collections were more frequent in symptomatic patients (n = 24) than in asymptomatic patients (n = 8, P=0.021). The MRI-based diagnosis was confirmed in all 14 patients who underwent revision surgery. |
2 |
| 148. Ylinen P, Tallroth K, Konttinen YT, Landtman M, Paavilainen T. Arthrography for the diagnosis of abductor avulsion after total hip arthroplasty: a comparison of arthrographic and surgical findings in 33 patients. Acta Orthop. 2007;78(3):340-343. |
Observational-Dx |
33 patients |
To determine accuracy of arthrography in the diagnosis of abductor avulsion after THA. |
After a mean follow-up time of 22 (2–57) months after THA, 14/33 patients had a positive (pathological) arthrogram whereas 19 had a negative (normal) result. All 14 patients with a positive arthrogram were verified to have an avulsion of the abductor muscle at the operation. 10/19 patients with a negative arthrogram had an intact abductor insertion, but 9 had an avulsion. All of these 9 patients with the preoperatively disclosed avulsion had a fibrous capsule, which obstructed the fistula leading from the joint cavity to the trochanteric bursa region. |
3 |
| 149. Bancroft LW, Blankenbaker DG. Imaging of the tendons about the pelvis. AJR Am J Roentgenol. 2010;195(3):605-617. |
Review/Other-Dx |
N/A |
To review the normal anatomy of the pelvic tendons as well as abnormalities such as tendinopathy, partial- and full-thickness tendon tears, myotendinous injuries, snapping hip syndrome, osseous avulsive injuries at tendinous attachments, calcific tendinitis, and tumor. |
MRI and US are useful imaging methods to directly evaluate suspected abnormalities of the pelvic tendons, although tendinous mineralization and associated osseous injuries can also be detected with radiography and CT. |
4 |
| 150. Garcia FL, Picado CH, Nogueira-Barbosa MH. Sonographic evaluation of the abductor mechanism after total hip arthroplasty. J Ultrasound Med. 2010;29(3):465-471. |
Review/Other-Dx |
34 patients |
To determine the frequency of abductor mechanism avulsion by US after THA with the Hardinge approach (J Bone Joint Surg Br 1982; 64:17-19) and its relationship to the presence of insufficiency of this musculature in the postoperative period. |
8 patients presented clinical insufficiency of the abductor musculature as detected by the Trendelenburg test. 4/8 patients with abductor insufficiency presented tendinous avulsion detected by sonography. 1 of the 4 patients with abductor insufficiency and normal sonographic findings had a decrease in the femoral offset caused by the arthroplasty itself. 2 patients presented electromyographic changes of the abductor musculature, with no tendinous avulsion detected by sonography and no abductor insufficiency. |
4 |
| 151. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
