[Value of digital subtraction arthrography and radionuclide arthrography in determination of indications and planning of revision surgery in total hip replacement]. / Stellenwert der digitalen Subtraktionsarthrografie und Arthroszintigrafie in der Indikationsstellung und Planung der Hüft-TEP-Wechseloperation.

PURPOSE: Clinical and radiographic findings are of little value in the diagnosis of hip endoprothesis loosening. Refined contrast and radionuclide arthrographic techniques are more precise in predicting endoprothesis loosening. Here we compare both techniques with respect to the surgical result. MATERIAL AND METHODS: 68 patients with hip pain after various arthroplasty procedure were investigated by clinical examination, X-ray, DSAr and AS. Surgical proof was obtained in 73.5%. RESULTS: An acetabular component loosening was detected in 89% by DSAr and in 86% by AS with a specificity for both methods of 93%. The femoral component loosening was seen with a sensitivity of 89% by DSAr and 100% by AS, respectively. Specificity of DSAr in the femoral compartment was 94%, of AS 88%. CONCLUSIONS: DSAr and AS are useful tools in the diagnosis of hip endoprothesis loosening and in planning surgical treatment. Both methods are comparable concerning the acetabular component, whereas AS is more sensitive in detecting femoral stem loosening. Combination of both methods is not recommended for routine diagnosis.