Specificity has consistently been high, ranging from 88% to 100%. Sensitivity has been more variable, ranging from 33% to 100% [88,95,96,116,117]. Variant 5: Symptomatic hip arthroplasty patient, infection excluded. Additional imaging following radiographs. This variant includes wear, loosening, and osteolysis. Bone Scan with SPECT or SPECT/CT Hip In 37 painful hip arthroplasties, the results of the bone scan with SPECT/CT were comparable to those of MRI for detecting polyethylene wear, periprosthetic fracture, infection, and aseptic loosening. MRI detected 21 soft tissue abnormalities, 14 tendon lesions (12 tendonopathies, 2 tears), 6 bursitis, and 1 pseudotumor. In contrast, bone scan with SPECT/CT found 1 soft tissue abnormality: iliopsoas tendinopathy, which also was identified on MRI [120]. CT Arthrography Hip Arthrography of the hip may be combined with CT [106]. However, most CT examinations of prostheses are not routinely performed with either IV or intraarticular contrast, particularly now that MAR algorithms for CT have been introduced [22,23]. CT Hip Liner wear: Liner wear may be detected on CT as thinning of the liner contour, development of a gap between a ceramic head and liner [22], shift of femoral head position within the acetabulum, and, in severe cases, metallic deposits in the soft tissues from contact between the femoral head and acetabular metal backing [122,123]. Loosening: Gillet et al [124] compared radiographs and CT with MAR (CT-MAR) for the diagnosis of component loosening. The sensitivity of CT for acetabular or femoral loosening was higher than for radiographs (33.3% and 51.5% for 2 readers for radiographs and 84.85 % for CT). The specificity of both radiographic and CT examinations was high and similar (96.9% and 100% for 2 readers for radiographs and 96.9% and 95.4% for CT). An advantage of CT is its ability to define the amount of the acetabular ingrowth surface that is in contact with bone [22].
Imaging after Total Hip Arthroplasty PCAs. Specificity has consistently been high, ranging from 88% to 100%. Sensitivity has been more variable, ranging from 33% to 100% [88,95,96,116,117]. Variant 5: Symptomatic hip arthroplasty patient, infection excluded. Additional imaging following radiographs. This variant includes wear, loosening, and osteolysis. Bone Scan with SPECT or SPECT/CT Hip In 37 painful hip arthroplasties, the results of the bone scan with SPECT/CT were comparable to those of MRI for detecting polyethylene wear, periprosthetic fracture, infection, and aseptic loosening. MRI detected 21 soft tissue abnormalities, 14 tendon lesions (12 tendonopathies, 2 tears), 6 bursitis, and 1 pseudotumor. In contrast, bone scan with SPECT/CT found 1 soft tissue abnormality: iliopsoas tendinopathy, which also was identified on MRI [120]. CT Arthrography Hip Arthrography of the hip may be combined with CT [106]. However, most CT examinations of prostheses are not routinely performed with either IV or intraarticular contrast, particularly now that MAR algorithms for CT have been introduced [22,23]. CT Hip Liner wear: Liner wear may be detected on CT as thinning of the liner contour, development of a gap between a ceramic head and liner [22], shift of femoral head position within the acetabulum, and, in severe cases, metallic deposits in the soft tissues from contact between the femoral head and acetabular metal backing [122,123]. Loosening: Gillet et al [124] compared radiographs and CT with MAR (CT-MAR) for the diagnosis of component loosening. The sensitivity of CT for acetabular or femoral loosening was higher than for radiographs (33.3% and 51.5% for 2 readers for radiographs and 84.85 % for CT). The specificity of both radiographic and CT examinations was high and similar (96.9% and 100% for 2 readers for radiographs and 96.9% and 95.4% for CT). An advantage of CT is its ability to define the amount of the acetabular ingrowth surface that is in contact with bone [22].