Imaging diagnosis of periprosthetic osteolysis after total hip arthroplasty / 中华放射学杂志

ABSTRACT

Objective To explore the imaging appearances of periprosthetic osteolysis after total hip arthroplasty(THA).Methods Imaging appearances of periprosthetic osteoleysis after THA in 24 cases confirmed by surgery and pathological examination were retrospectively analyzed.Twenty-four patients underwent X-ray examinations,and 17 of them underwent CT scanning additionally.Results (1) Location and typeOf the 24 cases with periprosthetic osteoleysis,23 femurs were involved (95.8％,expansile type in 15 cases and liner type in 8 cases).Lesions were located in Gruen 1-2 and 6-7 region (34.8％) in 8 cases,in Gruen 1 and 7 region in 8 cases (34.8％),in Gruen 1-7 region in 6 cases (26.0％),in Gruen 2-3 and 6 region in one case (4.3％).A total of 21 actabulums were involved (87.5％,expansile type in 14 cases and liner type in 7 cases included),with lesions located in Delee Ⅰ-Ⅲ in 14 cases (66.7％),in Delee Ⅰ and Ⅲ in 4 cases (19.0％),in Delee Ⅱ-Ⅲ in 2 cases (9.5％) and in Delee Ⅰ-Ⅱ in 1 case (4.8％).(2) Features of lesionsAdjacent cortex of the lucency lesion appeared irregular thin in 24 cases (100％),focally discontinuous in 18 cases (75.0％),disrupted in 16 cases (66.7％),and accompanied by a few tiny bony fragments in 10 cases (41.7％).Cortical thickening were seen near the lucency lesion in 3 cases(12.5％).Twenty-one cases (87.5％) presented with sclerotic margins,18 cases (75.0％) with crateriform interface.Of the 17 cases which underwent the CT scanning,16 cases (94.1％)had soft tissue mass.(3) Change of the prosthesisTwenty-one cases (87.5％) presented with linear wear,11 cases (45.8％) with bony defect near the screw.The screw penetration was seen in 3 cases (12.5％),fractured screws were seen in 2 cases (8.3％),and screw invagination was seen in 1 case (4.2％),metal debris was seen in 12 cases (50.0％).(4) ComplicationsNineteen cases (79.2％) presented with femur periprosthetic loosening,16 cases (66.7％) with actabulum periprosthetic loosening.Eleven cases (45.8％) presented with femur periprosthetic fractures,5 cases (20.8％) with actabulum periprosthetic fractures.Two cases (8.3％) had periprosthetic dislocation.Conclusions Linear or expansile lucent lesion of the bones around the prosthesis after THA,together with soft tissue mass and the imaging of linear wear can be diagnosed as the periprosthetic osteolysis.