The Journal of Bone and Joint Surgery (American) 84:609-614 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Use of Helical Computed Tomography for the Assessment of Acetabular Osteolysis After Total Hip Arthroplasty
Lalit Puri, MD,
Richard L. Wixson, MD,
Steven H. Stern, MD,
Joe Kohli, BA,
Ronald W. Hendrix, MD and
S. David Stulberg, MD
Investigation performed at the Departments of Orthopaedic Surgery
and Radiology, Northwestern University Medical School, Chicago,
Illinois
Lalit Puri, MD
1800 Lombard Street, Suite 801, Philadelphia, PA 19146
Richard L. Wixson, MD
Steven H. Stern, MD
Northwestern Center for Orthopedics, 676 North St. Clair Street,
Suite 450, Chicago, IL 60611
Joe Kohli, BA
Department of Orthopaedic Surgery, Northwestern University Medical
School, 645 North Michigan Avenue, Suite 1058B, Chicago, IL 60611
Ronald W. Hendrix, MD
Department of Radiology, Northwestern University Medical School,
676 North St. Clair Street, Suite 800 Chicago, IL 60611
S. David Stulberg, MD
Northwestern Orthopaedic Institute, 680 North Lake Shore Drive,
Suite 1028, Chicago, IL 60611
No benefits in any form have been received or will be received from
a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Background:
Acetabular osteolysis is a major problem affecting long-term survival
of total hip prostheses. Since lytic lesions may be asymptomatic
until extensive bone loss has occurred, early detection of lytic
lesions is important. The purposes of this study were to determine
the efficacy and potential role of high-resolution helical (or spiral)
computed tomography with metal-artifact minimization in the early
detection of osteolysis of the pelvis and to use the method to determine
if there was a relationship between the extent of osteolysis and
the amount of polyethylene wear.
Methods:
Forty patients (fifty hips) who had undergone primary cementless
total hip arthroplasty between 1988 and 1994 were evaluated as part
of an ongoing prospective study. These patients had a history of
high-level activity that was believed to place them at increased
risk for accelerated polyethylene wear. The most recent follow-up
radiographs were compared with the three-month postoperative radiographs.
Helical computed tomography scans with metal-artifact minimization were
made, and evidence of osteolytic lesions on these scans was compared
with that on the radiographs. Two-dimensional wear analysis was
performed with use of digitized radiographs, and the results were
compared with loss of bone volume as calculated from the computed
tomography scans.
Results:
Acetabular lysis was identified on the radiographs of sixteen hips
and on the computed tomography scans of twenty-six hips. Radiographs
underestimated the extent of the lysis in thirteen of the sixteen
hips. There was no correlation (r = 0.036) between linear wear and
the measured volume of bone loss, with the numbers available. On
the basis of the amount of lysis seen on the computed tomography
scans, one patient underwent a revision procedure.
Conclusions:
Helical computed tomography with metal-artifact minimization is
more sensitive for identifying and quantifying osteolysis after
total hip arthroplasty than is plain radiography. Since computed
tomography scans show both the extent and the location of lytic
lesions, they are useful to guide treatment decisions as well as
to assist in planning for surgical intervention, when needed, in
patients with suspected osteolysis.
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