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Radiographic Definition of Pelvic Osteolysis Following Total Hip Arthroplasty

Investigation performed at the Anderson Orthopaedic Research Institute, Alexandria, Virginia

Alexandra M. Claus, MD, PhD
Orthopädische Universitätsklinik Mannheim, Fakultät für Klinische Medizin der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3 68167 Mannheim, Germany. E-mail address: alexandra_claus{at}t-online.de

C. Anderson Engh Jr., MD
Christi J. Sychterz, MS
Karl F. Orishimo, MS
Charles A. Engh Sr., MD
Anderson Orthopaedic Research Institute, P.O. Box 7088, Alexandria, VA 22307

John S. Xenos, MD
Department of Orthopaedics, Walter Reed Army Medical Center, 6900 Georgia Avenue, Washington, DC 20307

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. 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. The Anderson Orthopaedic Research Institute acknowledges the INOVA Health Care System, our hospital base, for the general support of our research endeavors. The nature of this study was not influenced by this support.

Background: Radiographs are the standard clinical tool used to monitor patients with pelvic osteolysis after total hip arthroplasty; however, previous reports have questioned the value and accuracy of this method. With use of a cadaveric model, we investigated the accuracy of radiographs in determining the location and size of periacetabular osteolysis.

Methods: We implanted total hip arthroplasty components in eight cadaveric hips and made four radiographs of each hip from different views. We then removed the components and created two pelvic defects in each hip. We measured the volume of each defect, reimplanted the components, and made another set of radiographs. The defects were then enlarged two more times, with the volume measured and another set of radiographs made each time. In total, 128 radiographs were made of forty-eight lesions. An orthopaedist who was blinded to the location of the lesions assessed the radiographs with regard to the presence and size of osteolytic lesions.

Results: The overall sensitivity for the detection of osteolysis on a single radiograph was 41.5%, and the overall specificity was 93.0%. Sensitivity was dependent on the location and size of the lesions but not on the radiographic view. Sensitivity ranged from 72% for lesions in the ilium to 15% for lesions in the ischium and acetabular rim. The detection rate for lesions with a volume of >10 cm ³ was significantly higher than that for smaller lesions (p < 0.001). When all four radiographic views of one lesion were analyzed together, sensitivity increased to 73.6%. Despite the low sensitivity, specificity remained high, indicating that once osteolysis is evident radiographically, the likelihood that a lesion truly exists is high. Additionally, we found that the extent of osteolysis was substantially underestimated on radiographs.

Conclusions: The use of radiographs to assess and monitor osteolysis has both limitations and merits. Using multiple views, an experienced orthopaedist identified only 73.6% of pelvic lesions. However, once a pelvic osteolytic lesion is evident radiographically, the likelihood that it truly exists is high.

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