Semin Musculoskelet Radiol 2011; 15(4): 357-371
DOI: 10.1055/s-0031-1286016
© Thieme Medical Publishers

Imaging of the Postoperative Hip

Fiona L. Carty1 , James P. Cashman2 , Javad Parvizi2 , Adam C. Zoga1 , William B. Morrison1
  • 1Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
  • 2Department of Orthopedics, Thomas Jefferson University Hospital, Rothman Institute, Philadelphia, Pennsylvania
Further Information

Publication History

Publication Date:
16 September 2011 (online)

ABSTRACT

A basic understanding of the surgical approach, technique, and potential complications in addition to the types of hardware used is essential in interpreting postoperative imaging of the hip. This article reviews the various surgical approaches to the hip and hardware components in total hip arthroplasty and hip preservation surgery and the potential complications that may arise. The various surgical treatments in the management of acetabular dysplasia and avascular necrosis and the imaging appearances of these on different imaging modalities are also discussed.

REFERENCES

  • 1 Smith-Petersen M N. Approach to and exposure of the hip joint for mold arthroplasty.  J Bone Joint Surg Am. 1949;  31A (1) 40-46
  • 2 Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. 1970.  Clin Orthop Relat Res. 2005;  (430) 3-11; discussion 2
  • 3 Harris W H. A new lateral approach to the hip joint.  J Bone Joint Surg Am. 1967;  49 (5) 891-898
  • 4 Müller M E. Total hip prostheses.  Clin Orthop Relat Res. 1970;  72 46-68
  • 5 Lindholm R V, Puranen J, Kinnunen P. The Moore vitallium femoral-head prosthesis in fractures of the femoral neck.  Acta Orthop Scand. 1976;  47 (1) 70-78
  • 6 Breusch S J, Norman T L, Schneider U, Reitzel T, Blaha J D, Lukoschek M. Lavage technique in total hip arthroplasty: jet lavage produces better cement penetration than syringe lavage in the proximal femur.  J Arthroplasty. 2000;  15 (7) 921-927
  • 7 Jasty M, Maloney W J, Bragdon C R, O'Connor D O, Haire T, Harris W H. The initiation of failure in cemented femoral components of hip arthroplasties.  J Bone Joint Surg Br. 1991;  73 (4) 551-558
  • 8 Crowninshield R D, Brand R A, Johnston R C, Milroy J C. The effect of femoral stem cross-sectional geometry on cement stresses in total hip reconstruction.  Clin Orthop Relat Res. 1980;  (146) 71-77
  • 9 Anthony P P, Gie G A, Howie C R, Ling R S. Localised endosteal bone lysis in relation to the femoral components of cemented total hip arthroplasties.  J Bone Joint Surg Br. 1990;  72 (6) 971-979
  • 10 Callaghan J J, Forest E E, Olejniczak J P, Goetz D D, Johnston R C. Charnley total hip arthroplasty in patients less than fifty years old. A twenty to twenty-five-year follow-up note.  J Bone Joint Surg Am. 1998;  80 (5) 704-714
  • 11 McCormack B A, Prendergast P J, Gallagher D G. An experimental study of damage accumulation in cemented hip prostheses.  Clin Biomech (Bristol, Avon). 1996;  11 (4) 214-219
  • 12 Gruen T A, McNeice G M, Amstutz H C. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening.  Clin Orthop Relat Res. 1979;  (141) 17-27
  • 13 Barrack R L, Mulroy Jr R D, Harris W H. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review.  J Bone Joint Surg Br. 1992;  74 (3) 385-389
  • 14 Schulte K R, Callaghan J J, Kelley S S, Johnston R C. The outcome of Charnley total hip arthroplasty with cement after a minimum twenty-year follow-up. The results of one surgeon.  J Bone Joint Surg Am. 1993;  75 (7) 961-975
  • 15 García-Cimbrelo E, Diez-Vazquez V, Madero R, Munuera L. Progression of radiolucent lines adjacent to the acetabular component and factors influencing migration after Charnley low-friction total hip arthroplasty.  J Bone Joint Surg Am. 1997;  79 (9) 1373-1380
  • 16 Shelley P, Wroblewski B M. Socket design and cement pressurisation in the Charnley low-friction arthroplasty.  J Bone Joint Surg Br. 1988;  70 (3) 358-363
  • 17 Garcia-Cimbrelo E, Diaz-Martin A, Madero R, Munera L. Loosening of the cup after low-friction arthroplasty in patients with acetabular protrusion. The importance of the position of the cup.  J Bone Joint Surg Br. 2000;  82 (1) 108-115
  • 18 Berger R A, Jacobs J J, Quigley L R, Rosenberg A G, Galante J O. Primary cementless acetabular reconstruction in patients younger than 50 years old. 7- to 11-year results.  Clin Orthop Relat Res. 1997;  (344) 216-226
  • 19 Pohler O E. Unalloyed titanium for implants in bone surgery.  Injury. 2000;  31 (Suppl 4) 7-13
  • 20 Sharkey P F, Hozack W J, Callaghan J J et al.. Acetabular fracture associated with cementless acetabular component insertion: a report of 13 cases.  J Arthroplasty. 1999;  14 (4) 426-431
  • 21 Bobyn J D, Stackpool G J, Hacking S A, Tanzer M, Krygier J J. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial.  J Bone Joint Surg Br. 1999;  81 (5) 907-914
  • 22 Rahbek O, Kold S, Zippor B, Overgaard S, Søballe K. Particle migration and gap healing around trabecular metal implants.  Int Orthop. 2005;  29 (6) 368-374
  • 23 Agins H J, Alcock N W, Bansal M et al.. Metallic wear in failed titanium-alloy total hip replacements. A histological and quantitative analysis.  J Bone Joint Surg Am. 1988;  70 (3) 347-356
  • 24 Berry D J. Epidemiology: hip and knee.  Orthop Clin North Am. 1999;  30 (2) 183-190
  • 25 Hallab N J, Anderson S, Caicedo M, Skipor A, Campbell P, Jacobs J J. Immune responses correlate with serum-metal in metal-on-metal hip arthroplasty.  J Arthroplasty. 2004;  19 (8, Suppl 3) 88-93
  • 26 Willert H G, Buchhorn G H, Fayyazi A et al.. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study.  J Bone Joint Surg Am. 2005;  87 (1) 28-36
  • 27 Witzleb W C, Hanisch U, Kolar N, Krummenauer F, Guenther K P. Neo-capsule tissue reactions in metal-on-metal hip arthroplasty.  Acta Orthop. 2007;  78 (2) 211-220
  • 28 Huo M H, Parvizi J, Bal B S, Mont M A. What's new in total hip arthroplasty.  J Bone Joint Surg Am. 2009;  91 (10) 2522-2534
  • 29 Watanabe S, Ogata T. Clinical and experimental study upon primary pulmonary hypertension.  Jpn Circ J. 1976;  40 (6) 603-610
  • 30 Manaster B J. From the RSNA refresher courses. Total hip arthroplasty: radiographic evaluation.  Radiographics. 1996;  16 (3) 645-660
  • 31 Pluot E, Davis E T, Revell M, Davies A M, James S L. Hip arthroplasty. Part 2: normal and abnormal radiographic findings.  Clin Radiol. 2009;  64 (10) 961-971
  • 32 Fitzgerald Jr R H, Brindley G W, Kavanagh B F. The uncemented total hip arthroplasty. Intraoperative femoral fractures.  Clin Orthop Relat Res. 1988;  (235) 61-66
  • 33 Johnston R C, Fitzgerald Jr R H, Harris W H, Poss R, Müller M E, Sledge C B. Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results.  J Bone Joint Surg Am. 1990;  72 (2) 161-168
  • 34 Goodwin R A. The Austin Moore prosthesis in fresh femoral neck fractures. (A review of 611 post operative cases.)  Am J Orthop Surg. 1968;  10 (2) 40-43
  • 35 DeLee J G, Charnley J. Radiological demarcation of cemented sockets in total hip replacement.  Clin Orthop Relat Res. 1976;  (121) 20-32
  • 36 Dumbleton J H, Manley M T, Edidin A A. A literature review of the association between wear rate and osteolysis in total hip arthroplasty.  J Arthroplasty. 2002;  17 (5) 649-661
  • 37 Willert H G, Bertram H, Buchhorn G H. Osteolysis in alloarthroplasty of the hip. The role of ultra-high molecular weight polyethylene wear particles.  Clin Orthop Relat Res. 1990;  (258) 95-107
  • 38 Brooker A F, Bowerman J W, Robinson R A, Riley Jr L H. Ectopic ossification following total hip replacement. Incidence and a method of classification.  J Bone Joint Surg Am. 1973;  55 (8) 1629-1632
  • 39 Sanchis-Alfonso V. Severe metallosis after unicompartmental knee arthroplasty.  Knee Surg Sports Traumatol Arthrosc. 2007;  15 (4) 361-364
  • 40 Gambera D, Carta S, Crainz E, Fortina M, Maniscalco P, Ferrata P. Metallosis due to impingement between the socket and the femoral head in a total hip prosthesis. A case report.  Acta Biomed. 2002;  73 (5-6) 85-91
  • 41 Miki H, Sugano N, Yamamura M, Nakamura N, Nishii T, Yoshikawa H. Serious metallosis of a metal head due to fragmented ceramic screws in a cemented THA.  Arch Orthop Trauma Surg. 2006;  126 (3) 192-196
  • 42 Quale J L, Murphey M D, Huntrakoon M, Reckling F W, Neff J R. Titanium-induced arthropathy associated with polyethylene-metal separation after total joint replacement.  Radiology. 1992;  182 (3) 855-858
  • 43 Heffernan E J, Alkubaidan F O, Nielsen T O, Munk P L. The imaging appearances of metallosis.  Skeletal Radiol. 2008;  37 (1) 59-62
  • 44 Puri L, Wixson R L, Stern S H, Kohli J, Hendrix R W, Stulberg S D. Use of helical computed tomography for the assessment of acetabular osteolysis after total hip arthroplasty.  J Bone Joint Surg Am. 2002;  84-A (4) 609-614
  • 45 Reinus W R, Merkel K C, Gilden J J, Berger K L. Evaluation of femoral prosthetic loosening using CT imaging.  AJR Am J Roentgenol. 1996;  166 (6) 1439-1442
  • 46 Cyteval C, Hamm V, Sarrabère M P, Lopez F M, Maury P, Taourel P. Painful infection at the site of hip prosthesis: CT imaging.  Radiology. 2002;  224 (2) 477-483
  • 47 Tigges S, Stiles R G, Roberson J R. Appearance of septic hip prostheses on plain radiographs.  AJR Am J Roentgenol. 1994;  163 (2) 377-380
  • 48 Harris W H, Barrack R L. Contemporary algorithms for evaluation of the painful total hip replacement.  Orthop Rev. 1993;  22 (5) 531-539
  • 49 Sofka C M, Potter H G. MR imaging of joint arthroplasty.  Semin Musculoskelet Radiol. 2002;  6 (1) 79-85
  • 50 Potter H G, Nestor B J, Sofka C M, Ho S T, Peters L E, Salvati E A. Magnetic resonance imaging after total hip arthroplasty: evaluation of periprosthetic soft tissue.  J Bone Joint Surg Am. 2004;  86-A (9) 1947-1954
  • 51 Johnston C, Kerr J, Ford S, O'Byrne J, Eustace S. MRI as a problem-solving tool in unexplained failed total hip replacement following conventional assessment.  Skeletal Radiol. 2007;  36 (10) 955-961
  • 52 Koulouris G, Morrison W B. MR imaging of hip infection and inflammation.  Magn Reson Imaging Clin N Am. 2005;  13 (4) 743-755
  • 53 White L M, Kim J K, Mehta M et al.. Complications of total hip arthroplasty: MR imaging-initial experience.  Radiology. 2000;  215 (1) 254-262
  • 54 Sugimoto H, Hirose I, Miyaoka E et al.. Low-field-strength MR imaging of failed hip arthroplasty: association of femoral periprosthetic signal intensity with radiographic, surgical, and pathologic findings.  Radiology. 2003;  229 (3) 718-723
  • 55 Steffen R T, Foguet P R, Krikler S J, Gundle R, Beard D J, Murray D W. Femoral neck fractures after hip resurfacing.  J Arthroplasty. 2009;  24 (4) 614-619
  • 56 Hardinge K. The direct lateral approach to the hip.  J Bone Joint Surg Br. 1982;  64 (1) 17-19
  • 57 Ganz R, Gill T J, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis.  J Bone Joint Surg Br. 2001;  83 (8) 1119-1124
  • 58 Shimmin A J, Back D. Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases.  J Bone Joint Surg Br. 2005;  87 (4) 463-464
  • 59 Hart A J, Sabah S, Henckel J et al.. The painful metal-on-metal hip resurfacing.  J Bone Joint Surg Br. 2009;  91 (6) 738-744
  • 60 Hing C B, Back D L, Bailey M, Young D A, Dalziel R E, Shimmin A J. The results of primary Birmingham hip resurfacings at a mean of five years. An independent prospective review of the first 230 hips.  J Bone Joint Surg Br. 2007;  89 (11) 1431-1438
  • 61 Spencer S, Carter R, Murray H, Meek R M. Femoral neck narrowing after metal-on-metal hip resurfacing.  J Arthroplasty. 2008;  23 (8) 1105-1109
  • 62 Langton D J, Jameson S S, Joyce T J, Hallab N J, Natu S, Nargol A V. 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 (1) 38-46
  • 63 Kwon Y M, Ostlere S J, McLardy-Smith P, Athanasou N A, Gill H S, Murray D W. “Asymptomatic” pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalence and metal ion study.  J Arthroplasty. 2011;  26 (4) 511-518
  • 64 Fang C S, Harvie P, Gibbons C L, Whitwell D, Athanasou N A, Ostlere S. The imaging spectrum of peri-articular inflammatory masses following metal-on-metal hip resurfacing.  Skeletal Radiol. 2008;  37 (8) 715-722
  • 65 McGrory B J, York S C, Iorio R et al.. Current practices of AAHKS members in the treatment of adult osteonecrosis of the femoral head.  J Bone Joint Surg Am. 2007;  89 (6) 1194-1204
  • 66 Colwell Jr C W. The controversy of core decompression of the femoral head for osteonecrosis.  Arthritis Rheum. 1989;  32 (6) 797-800
  • 67 Kristensen K D, Pedersen N W, Kiaer T, Starklint H. Core decompression in femoral head osteonecrosis. 18 stage I hips followed up for 1-5 years.  Acta Orthop Scand. 1991;  62 (2) 113-114
  • 68 Warner J J, Philip J H, Brodsky G L, Thornhill T S. Studies of nontraumatic osteonecrosis. The role of core decompression in the treatment of nontraumatic osteonecrosis of the femoral head.  Clin Orthop Relat Res. 1987;  (225) 104-127
  • 69 Berend K R, Gunneson E E, Urbaniak J R. Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head.  J Bone Joint Surg Am. 2003;  85-A (6) 987-993
  • 70 Ng V Y, Granger J F, Ellis T J. Calcium phosphate cement to prevent collapse in avascular necrosis of the femoral head.  Med Hypotheses. 2010;  74 (4) 725-726
  • 71 Scully S P, Aaron R K, Urbaniak J R. Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis.  J Bone Joint Surg Am. 1998;  80 (9) 1270-1275
  • 72 Wirtz C, Zilkens K W, Adam G, Niethard F U. MRI-controlled outcome after core decompression of the femur head in aseptic osteonecrosis and transient bone marrow edema[in German].  Z Orthop Ihre Grenzgeb. 1998;  136 (2) 138-146
  • 73 Neuhold A, Hofmann S, Engel A et al.. Bone marrow edema of the hip: MR findings after core decompression.  J Comput Assist Tomogr. 1992;  16 (6) 951-955
  • 74 Yoo M C, Kim K I, Hahn C S, Parvizi J. Long-term follow-up of vascularized fibular grafting for femoral head necrosis.  Clin Orthop Relat Res. 2008;  466 (5) 1133-1140
  • 75 Bobyn J D, Poggie R A, Krygier J J et al.. Clinical validation of a structural porous tantalum biomaterial for adult reconstruction.  J Bone Joint Surg Am. 2004;  86-A (Suppl 2) 123-129
  • 76 Shuler M S, Rooks M D, Roberson J R. Porous tantalum implant in early osteonecrosis of the hip: preliminary report on operative, survival, and outcomes results.  J Arthroplasty. 2007;  22 (1) 26-31
  • 77 Reuter N, Romier A, Hambourg Z et al.. Cementoplasty in the treatment of avascular necrosis of the hip.  J Rheumatol. 2009;  36 (2) 385-389
  • 78 Gautier E, Ganz K, Krügel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications.  J Bone Joint Surg Br. 2000;  82 (5) 679-683
  • 79 Vaughn Z D, Safran M R. Arthroscopic femoral osteoplasty/chielectomy for cam-type femoroacetabular impingement in the athlete.  Sports Med Arthrosc. 2010;  18 (2) 90-99
  • 80 Clohisy J C, McClure J T. Treatment of anterior femoroacetabular impingement with combined hip arthroscopy and limited anterior decompression.  Iowa Orthop J. 2005;  25 164-171
  • 81 Laude F, Sariali E, Nogier A. Femoroacetabular impingement treatment using arthroscopy and anterior approach.  Clin Orthop Relat Res. 2009;  467 (3) 747-752
  • 82 Ganz R, Klaue K, Vinh T S, Mast J W. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. 1988.  Clin Orthop Relat Res. 2004;  (418) 3-8

Fiona L CartyM.D. F.F.R. R.C.S.I. 

Department of Radiology, Thomas Jefferson University Hospital

132 South 10th St., Philadelphia, PA 19107

Email: fcarty@gmail.com