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Imaging of prosthetic joints

Department of Radiology, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK

• Plain films are usually sufficient to assess the state of a prosthesis.
  
• The main complications following joint replacement are infection and loosening.
  
• It is important to differentiate between infection and aseptic loosening, as the management differs considerably.
  
• The wider and more extensive the periprosthetic lucency, the higher the chance of loosening. Progressive changes are more significant.
  
• Techniques to reduce artefacts in CT and MRI have led to the increased use of these modalities in the investigation of prosthetic joints.
  
• Ultrasound is useful in assessing soft-tissue collections and for guiding joint aspiration and capsular biopsy.
  
• Scintigraphy is a sensitive but non-specific technique for diagnosing loosening.
  

An increasing percentage of our population is having joint replacements, and therefore it is important for the radiologist to have sufficient knowledge of the types of joint replacements and their complications in order to make an accurate radiological assessment of prosthetic joints. Plain films are the mainstay for assessing joint replacements. However, other imaging modalities all have a part to play in the investigation of complications. This article discusses the radiological assessment following hip, knee, shoulder, elbow and ankle arthroplasty. The main complications of infection and loosening are discussed in detail, as is the importance of differentiating between infection and aseptic loosening. The appearances and criteria for diagnosing loosening depend on the site and type of prosthesis used. Examples of complications of cemented, uncemented and resurfacing hip prostheses are demonstrated. Total knee replacements and uni-compartment knee replacements are discussed, and complications following shoulder, elbow and ankle arthroplasty are also demonstrated. The role of ultrasound, CT, MRI and nuclear medicine techniques in evaluating the complications of joint replacements is discussed.