Galley et al [110] used optimized MRI sequences and found irregular soft tissue mass, soft tissue edema, bone destruction, and fistulas to be significant features of periprosthetic infection, with sensitivities of 47.4% to 100% and specificities of 73.1% to 100.0%. Albano et al [109] found lymph node assessment (of the affected compared to the unaffected hip) identified infected implants with high accuracies (up to 93.1%). Galley et al [110] found periosteal reaction, capsular edema, and intramuscular edema after THA at 1.5T MRI with MAR to have high accuracy in the evaluation of periprosthetic joint infection (86%-91% accuracy). Schwaiger et al [112] were able to distinguish patients with infection from those with loosening using MRI features. Soft tissue edema (sensitivity, 86.7% and specificity, >73.3%), abnormalities at both acetabular and femoral components (sensitivity/specificity, 66.7%/93.3%-100%), and enlarged lymph nodes (80%/86.7%) enabled this differentiation. Radiographic Arthrography Hip There is no recent literature to support the current use of conventional arthrography of the hip in the evaluation of periprosthetic infection. US Hip Detection of joint effusion, fluid collections, and sinus tracts is possible with US, and, therefore, this modality is helpful in identifying infection [47]. Some discrepancy regarding the reliability and threshold for detecting effusion on US has been noted [47,114]. van Holsbeeck et al [115] used US to evaluate 15 asymptomatic patients with total Imaging After Total Hip Arthroplasty hip replacements and 33 patients who had pain in the hip after arthroplasty and radiologic findings consistent with component loosening (6 of whom had infection). All patients with intraarticular effusion and extraarticular extension had infection (100% specificity). WBC Scan and Sulfur Colloid Scan Hip The role of combined leukocyte and marrow imaging for diagnosing periprosthetic hip infection has been studied by several investigators.
Imaging after Total Hip Arthroplasty PCAs. Galley et al [110] used optimized MRI sequences and found irregular soft tissue mass, soft tissue edema, bone destruction, and fistulas to be significant features of periprosthetic infection, with sensitivities of 47.4% to 100% and specificities of 73.1% to 100.0%. Albano et al [109] found lymph node assessment (of the affected compared to the unaffected hip) identified infected implants with high accuracies (up to 93.1%). Galley et al [110] found periosteal reaction, capsular edema, and intramuscular edema after THA at 1.5T MRI with MAR to have high accuracy in the evaluation of periprosthetic joint infection (86%-91% accuracy). Schwaiger et al [112] were able to distinguish patients with infection from those with loosening using MRI features. Soft tissue edema (sensitivity, 86.7% and specificity, >73.3%), abnormalities at both acetabular and femoral components (sensitivity/specificity, 66.7%/93.3%-100%), and enlarged lymph nodes (80%/86.7%) enabled this differentiation. Radiographic Arthrography Hip There is no recent literature to support the current use of conventional arthrography of the hip in the evaluation of periprosthetic infection. US Hip Detection of joint effusion, fluid collections, and sinus tracts is possible with US, and, therefore, this modality is helpful in identifying infection [47]. Some discrepancy regarding the reliability and threshold for detecting effusion on US has been noted [47,114]. van Holsbeeck et al [115] used US to evaluate 15 asymptomatic patients with total Imaging After Total Hip Arthroplasty hip replacements and 33 patients who had pain in the hip after arthroplasty and radiologic findings consistent with component loosening (6 of whom had infection). All patients with intraarticular effusion and extraarticular extension had infection (100% specificity). WBC Scan and Sulfur Colloid Scan Hip The role of combined leukocyte and marrow imaging for diagnosing periprosthetic hip infection has been studied by several investigators.