Imaging in peri-prosthetic assessment: an orthopaedic perspective

Area of Science:

• Orthopaedic Surgery
• Radiology
• Biomedical Engineering

Background:

• Imaging techniques for joint replacements are continuously evolving.
• Evaluating implant osseointegration and loosening is critical in orthopaedic patient care.
• Adverse tissue reactions around implants require accurate assessment.

Purpose of the Study:

• To provide an overview of various imaging modalities for joint replacements.
• To discuss the role of imaging in assessing implant osseointegration and loosening (septic and aseptic).
• To highlight specific imaging features for major joints and address limitations.

Main Methods:

• Review of current imaging modalities and their applications in joint replacement evaluation.
• Discussion of limitations, standardization, and validity issues across techniques.
• Focus on imaging features for shoulder, hip, knee, and ankle joints.

Main Results:

• A lack of standardization and universal validity exists among imaging techniques.
• Plain radiographs are recommended for suspected peri-prosthetic joint infections.
• Ultrasound and radiographs are useful for initial screening of aseptic loosening; MARS MRI shows promise.

Conclusions:

• No single imaging technique covers all aspects of implant fixation and loosening evaluation.
• The choice of imaging modality should consider clinical context, availability, expertise, and cost.
• Close collaboration between radiologists and orthopaedic surgeons is essential for optimal patient management.