A possible exception might be for detection of a ceramic acetabular liner fracture where case reports suggest CT to be more sensitive than radiographs [53]. Fluoride PET/CT Skull Base to Mid-Thigh There is insufficient evidence to support the use of fluoride PET/CT skull base to mid-thigh as the initial imaging procedure in the evaluation of the symptomatic hip arthroplasty. Image-Guided Aspiration Hip There is no relevant literature to support the use of image-guided aspiration of the hip as the initial imaging procedure in the evaluation of the symptomatic hip arthroplasty. MRI Hip Non-MoM hip prostheses: There is insufficient evidence to support the use of MRI of the hip as the initial imaging modality for the patient with a symptomatic non-MoM arthroplasty. MoM hip prostheses: Because radiographs may be normal in patients with symptomatic pseudotumors [54], advanced imaging has been supported. Based on literature review, Petscavage-Thomas and Ha [49] suggested MARS-MRI as the first-line of imaging for detection of ARMD. Radiography Hip Radiographs are usually the first imaging modality for assessment of a patient with a symptomatic hip prosthesis. Non-MoM hip prostheses: The literature indicates that radiographs are usually the first imaging modality for assessment of a patient with a symptomatic hip prosthesis. Comparison radiographs are useful; however, an assessment of stem loosening on comparison studies may be suboptimal due to variables such as differences in hip flexion or rotation [55]. Some radiographic features such as increased femoral head and stem offset suggest the need for additional imaging for ARMD due to trunnionosis [56]. Metallosis may be identified around nonmetal on metal prostheses due to trunnionosis or following severe liner wear and/or liner dislocation or fracture [14,57-59].
Imaging after Total Hip Arthroplasty PCAs. A possible exception might be for detection of a ceramic acetabular liner fracture where case reports suggest CT to be more sensitive than radiographs [53]. Fluoride PET/CT Skull Base to Mid-Thigh There is insufficient evidence to support the use of fluoride PET/CT skull base to mid-thigh as the initial imaging procedure in the evaluation of the symptomatic hip arthroplasty. Image-Guided Aspiration Hip There is no relevant literature to support the use of image-guided aspiration of the hip as the initial imaging procedure in the evaluation of the symptomatic hip arthroplasty. MRI Hip Non-MoM hip prostheses: There is insufficient evidence to support the use of MRI of the hip as the initial imaging modality for the patient with a symptomatic non-MoM arthroplasty. MoM hip prostheses: Because radiographs may be normal in patients with symptomatic pseudotumors [54], advanced imaging has been supported. Based on literature review, Petscavage-Thomas and Ha [49] suggested MARS-MRI as the first-line of imaging for detection of ARMD. Radiography Hip Radiographs are usually the first imaging modality for assessment of a patient with a symptomatic hip prosthesis. Non-MoM hip prostheses: The literature indicates that radiographs are usually the first imaging modality for assessment of a patient with a symptomatic hip prosthesis. Comparison radiographs are useful; however, an assessment of stem loosening on comparison studies may be suboptimal due to variables such as differences in hip flexion or rotation [55]. Some radiographic features such as increased femoral head and stem offset suggest the need for additional imaging for ARMD due to trunnionosis [56]. Metallosis may be identified around nonmetal on metal prostheses due to trunnionosis or following severe liner wear and/or liner dislocation or fracture [14,57-59].