Imaging study of aseptic loosening of the acetabular cup after cementless total hip arthroplasty: a retrospective study

Aoyang He ¹, Yao Zhang ¹, Chunmiao Lu ¹

⁰Department of Radiology, Hebei Medical University Third Hospital, Shijiazhuang, 050051, China.

Bmc Musculoskeletal Disorders +

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April 21, 2025

View abstract on PubMed

Summary

This study introduces new imaging criteria for diagnosing acetabular cup aseptic loosening after total hip arthroplasty. These criteria improve accuracy without needing baseline or serial radiographs, aiding in prosthetic loosening detection.

Area Of Science

Orthopedic surgery
Radiology
Biomedical engineering

Background

Acetabular cup loosening is a common complication after cementless total hip arthroplasty.
Accurate diagnosis is crucial for timely intervention and improved patient outcomes.
Current diagnostic methods can be limited, especially in cases lacking baseline or serial follow-up radiographs.

Purpose Of The Study

To establish more accurate imaging diagnostic parameters for acetabular cup aseptic loosening.
To identify key radiological characteristics indicative of loosening.
To develop criteria applicable even without postoperative baseline or serial follow-up radiographs.

Main Methods

Retrospective study of radiographic data from patients undergoing cementless total hip arthroplasty.
Inclusion of a loosening group (n=41) and a control group (n=61).
Measurement of acetabular cup inclination (AA), acetabular difference in vertical distance (DVD1, DVD2), acetabular difference in horizontal distance (DHD), wide radiolucent zones (TA), number of wide radiolucent zones (NTA), and difference in head-cup edge distance (DHCD).

Main Results

Significant differences (P < 0.05) in TA, DVD1, DHCD, AA, and NTA between the loosening and control groups.
Critical values established: DVD1 (1.49 cm), DHCD (0.16 cm), AA (53.2°), and NTA (1).
Combined criteria (NTA ≥ 1 and AA ≥ 53.2° or DHCD ≥ 0.16 cm) showed statistically significant validation.

Conclusions

The developed combined imaging criteria offer superior diagnostic efficacy for acetabular cup aseptic loosening compared to single parameters.
This diagnostic approach is effective without reliance on postoperative baseline or serial follow-up radiographs.
The criteria accurately determine the specific location of prosthetic loosening.

Keywords:

Aseptic loosening Complications Diagnostic imaging Multimodal image Total hip arthroplasty