The Journal of Bone and Joint Surgery (American) 83:1865-1870 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Comparison of Preoperative Radiographs and Intraoperative Findings of Fixation of Hemispheric Porous-Coated Sockets
Pacharapol Udomkiat, MD,
Zhinian Wan, MD and
Lawrence D. Dorr, MD
Investigation performed at The Arthritis Institute at Centinela
Hospital Medical Center, Inglewood, California
Pacharapol Udomkiat, MD
Zhinian Wan, MD
Lawrence D. Dorr, MD
The Arthritis Institute at Centinela Hospital Medical Center,
501 East Hardy Street, 3rd Floor, Inglewood, CA 90301
In support of their research or preparation of this manuscript,
one or more of the authors received grants or outside funding from
the Orthopedic Research Institute at Good Samaritan Hospital, Los
Angeles, California. In addition, one or more of the authors received
payments or other benefits or a commitment or agreement to provide
such benefits from a commercial entity (Sulzer Medica). No commercial
entity paid or directed, or agreed to pay or direct, any benefits
to any research fund, foundation, educational institution, or other
charitable or nonprofit organization with which the authors are
affiliated or associated.
Background: The radiographic criteria for identification
of loose cementless acetabular components have not been well established.
The purpose of this study was to compare the radiographic appearance
of a hemispheric porous-coated cementless cup fixed with screws
with the intraoperative findings with regard to the fixation status.
Methods: The quality of the cup fixation was evaluated
at fifty-two hip revisions that were performed, for reasons other than
infection, at an average of 89.9 months (range, 33.8 to 150.1 months)
after the primary operations. The fixation status at the revision
surgery was compared with the findings on sequential anteroposterior
and lateral radiographs of these sockets. Sequential radiographs
of an additional 100 total hip replacements that had not required
a reoperation and that had been followed for an average of 121 months
were also measured.
Results: Loosening of the socket was radiographically
identified by (1) radiolucent lines that initially appeared after
two years, (2) progression of radiolucent lines after two years,
(3) radiolucent lines in all three zones, (4) radiolucent lines
2 mm or wider in any zone, or (5) migration. The sensitivity of
these criteria was 94%, and the specificity was 100%.
The criteria had a positive predictive value of 100% and
a negative predictive value of 97%.
Conclusions: The most predictive radiographic findings
for early diagnosis of loosening of a hemispheric porous-coated cup
were progression of radiolucent lines more than two years after
the operation and any new radiolucent line of 1 mm or wider that
appeared more than two years postoperatively. Sequential anteroposterior
and lateral radiographs are necessary to assess the time of onset and
progression of radiolucent lines in order to identify loose hemispheric
porous-coated cups accurately.
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