Imaging Diagnosis Of Periprosthetic Osteolysis After Total Hip Arthroplasty

ObjectiveTo explore the imaging appearances of periprosthetic osteoleysis after total hip arthroplasty (THA) in order to improve the recognition of the disease.MethodsImaging appearances of periprosthetic osteoleysis after total hip arthroplasty in24cases confirmed by surgery and pathological examination were retrospectively analyzed. Twenty-four patients underwent X-ray examinations) and17of them underwent CT scanning additionally.Results(1) Location and type:Of the24cases with periprosthetic osteoleysis,23femurs were involved (95.8%, expansile type in15cases, liner type in8cases).Lesions were located in Gruen1～2、6-7zone(34.8%) in8cases, in Gruenl and7region in8cases (34.8%), in Gruenl～7zone in6cases (26.0%), in Gruen2～3and6region in one case (4.3%).A total of21actabulums were involved (87.5%, expansile type in14cases and liner type in7cases included), with lesions located in Delee Ⅰ-Ⅲ in14cases (66.7%), in Delee Ⅰ and Ⅲ in4cases(19.0%), in Delee Ⅱ-Ⅲ in2cases (9.5%) and in Delee Ⅰ-Ⅱ in one case (4.8%).(2) Features of lesions:Adjacent cortex of the lucency lesion appeared irregular thin in24cases (100%), focally discontinuous in18cases(75.0%), disrupted in16cases(66.7%), and accompanied by a few tiny bony fragments in10cases(41.7%). Cortical thickening were seen near the lucency lesion in3cases (12.5%).Twenty-one cases(87.5%) presented with sclerotic margins,18cases(75.0%) with crateriform interface. Of the17cases which underwent the CT scanning,16cases(94.1%) had soft tissue mass.(3) Change of the prosthesis:Twenty-one cases(87.5%) presented with liner wear,11cases (45.8%) with bony defect near the screw. The screw penetration was seen in3cases(12.5%), fractured screws were seen in2cases(8.3%), and screw invagination was seen in one case(4.2%), metal debris was seen in12cases(50.0%).(4) Complications:Nineteen cases (79.2%) presented with femur periprosthetic loosening,16cases(66.7%) with actabulum periprosthetic loosening. Eleven cases(45.8) presented with fumer periprosthetic fractures,5cases(20.8%) with actabulum periprosthetic fractures. Two cases(8.3%) had periprosthetic dislocation. ConclusionsLiner or expansile lucent lesion of the bones around the prosthesis after total hip arthroplasty(THA), together with soft tissue mass and the imaging of linear wear can be diagnosed as the periprosthetic osteolysis.