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The Journal of Bone and Joint Surgery, Vol 66, Issue 4 540-546, Copyright © 1984 by Journal of Bone and Joint Surgery, Inc
Failed total hip replacement: assessment by plain radiographs, arthrograms, and aspiration of the hip joint
DA O'Neill and WH Harris
We reviewed a series of sixty-one revised total hip replacements in order
to assess the accuracy of plain radiographs (all hips), arthrograms
(thirty-one hips), and aspiration (sixty hips) in demonstrating the
presence of loosening or infection. Plain radiographs correctly showed the
status of the fixation of 92 per cent of the femoral components but of only
63 per cent of the sockets. They indicated loosening in only 37 per cent of
the loose sockets. Arthrography improved the over-all accuracy in
demonstrating the status of the fixation of the sockets to 80 per cent and
increased the accurate detection of loose sockets to 89 per cent; however,
it was no more useful than the plain radiographs in the assessment of the
femoral components. Aspiration of the joint proved reliable in excluding
the possibility of infection in fifty-nine of sixty hips. We concluded that
femoral components are best evaluated for loosening by plain radiographs,
but arthrography substantially improves the diagnostic accuracy for
loosening of the socket. Aspiration of the joint accurately excluded sepsis
as the cause of pain in all of the hips from which joint fluid was
obtained.
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