Radiologic evaluation of painful joint prostheses

Area of Science:

• Orthopedic Surgery
• Radiology
• Medical Imaging

Background:

• Painful total joint prostheses often indicate clinical failure.
• Prosthetic loosening is a common cause of failure, typically detected late.
• Radiographic evaluation is crucial for diagnosing complications.

Purpose of the Study:

• To outline the diagnostic methods for evaluating painful total joint prostheses.
• To highlight the role of imaging in identifying prosthetic failure.
• To guide the management of asymptomatic loosening.

Main Methods:

• Review of sequential radiographs for abnormalities.
• Radionuclide bone scanning (Tc-99m diphosphonate agents) for equivocal cases.
• Arthrography for confirming loosening and detecting complications.

Main Results:

• Radiographs reveal abnormalities in most clinical failures (alignment, interfaces, bone contour, component integrity).
• Bone scans show increased uptake in infection; normal scans suggest unlikely infection or loosening.
• Positive arthrograms confirm loosening and abscesses; negative results are less significant.

Conclusions:

• Sequential radiographs are the primary tool for evaluating painful joint prostheses.
• Radionuclide bone scanning and arthrography supplement plain radiographs in diagnosis.
• Asymptomatic loosening requires monitoring with serial radiographs for progression.