1
|
Giai Via R, Onorato F, Reboli M, Artiaco S, Giachino M, Bosco F, Massè A. Challenges in Total Hip Arthroplasty with Prior Spinal Arthrodesis: A Comprehensive Review of Biomechanics, Complications, and Surgical Strategies. J Clin Med 2024; 13:3156. [PMID: 38892866 PMCID: PMC11172849 DOI: 10.3390/jcm13113156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Total hip arthroplasty (THA) has revolutionized patients' lives with hip osteoarthritis. However, the increasing prevalence of THA in individuals with prior lumbar arthrodesis (LA) poses unique challenges. This review delves into the biomechanical alterations, complications, and surgical strategies specific to this patient subset, highlighting the need for tailored preoperative assessments and planning. Due to altered pelvic and spinal biomechanics, patients with LA undergoing THA face a higher risk of dislocation and revision. The complex interplay between spinal and hip biomechanics underscores the need for meticulous preoperative planning. Comprehensive clinical examination and radiographic evaluation are vital for understanding patient-specific challenges. Various radiographic techniques, including computed tomography (CT)/X-ray matching and standing/seated studies, provide insights into postural changes affecting pelvic and spinal alignment. Complications following THA in patients with LA highlight the necessity for personalized surgical strategies. Careful consideration of implant selection, the surgical approach, and component positioning are essential to prevent complications. In summary, THA in patients with prior LA demands individualized preoperative assessments and planning. This approach is crucial to optimize outcomes and mitigate the heightened risks of complications, underlining the importance of tailored surgical strategies.
Collapse
Affiliation(s)
- Riccardo Giai Via
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, University of Turin, 10125 Turin, Italy; (R.G.V.); (F.O.); (M.R.); (S.A.); (M.G.); (A.M.)
| | - Francesco Onorato
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, University of Turin, 10125 Turin, Italy; (R.G.V.); (F.O.); (M.R.); (S.A.); (M.G.); (A.M.)
| | - Michele Reboli
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, University of Turin, 10125 Turin, Italy; (R.G.V.); (F.O.); (M.R.); (S.A.); (M.G.); (A.M.)
| | - Stefano Artiaco
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, University of Turin, 10125 Turin, Italy; (R.G.V.); (F.O.); (M.R.); (S.A.); (M.G.); (A.M.)
| | - Matteo Giachino
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, University of Turin, 10125 Turin, Italy; (R.G.V.); (F.O.); (M.R.); (S.A.); (M.G.); (A.M.)
| | - Francesco Bosco
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90133 Palermo, Italy
- Department of Orthopaedics and Traumatology, G.F. Ingrassia Hospital Unit, ASP 6, 90131 Palermo, Italy
- Department of Orthopedic and Traumatology (DICHIRONS), University of Palermo, 90127 Palermo, Italy
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, University of Turin, 10125 Turin, Italy; (R.G.V.); (F.O.); (M.R.); (S.A.); (M.G.); (A.M.)
| |
Collapse
|
2
|
Giai Via R, Migliorini F, Bosco F, Onorato F, Secco DC, Giustra F, Lavia AD, Giachino M, Massè A. Superior outcomes of total hip arthroplasty without prior lumbar arthrodesis: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:699-711. [PMID: 37847406 PMCID: PMC10857961 DOI: 10.1007/s00590-023-03761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE The number of patients undergoing total hip arthroplasty (THA) surgery after previous lumbar arthrodesis (LA) is rising. Literature suggests that LA may significantly impact pelvic biomechanics and potentially compromise the success of prosthetic hip replacement. This study aims to evaluate complication rates, dislocation rates, and revision rates in patients with prior LA undergoing THA surgery compared to those undergoing THA surgery without prior LA. METHODS A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A PICOS template was developed to ensure a structured approach. The search for relevant studies was performed across five databases, including Pubmed, Scopus, Embase, Medline, and Cochrane. The selected articles were evaluated based on the Levels of Evidence (LoE) criteria. The Coleman Methodology Score (mCMS) was employed to analyze the retrospective studies. This systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that allowed for a meta-analysis performed using R software, a p < 0.05 was considered statistically significant. RESULTS The final analysis included seventeen studies comprising a total of 3,139,164 cases of THA. Among these cases, 3,081,137 underwent THA surgery alone, while 58,027 patients underwent THA with a previous LA. The study investigated various factors, including dislocation rates, revision rates, and complication, as well as the surgical approach and type of implant used, for both the THA-only group and the group of patients who underwent THA with prior LA. The analysis revealed a statistically significant difference (p < 0.05) for all variables studied, favoring the group of patients who underwent THA alone without prior LA. CONCLUSIONS This systematic review and meta-analysis demonstrated a statistically significant superiority in all analyzed outcomes for patients who underwent THA-only without prior LA. Specifically, patients with isolated THA implants experienced significantly lower incidences of THA dislocation, wound complications, periprosthetic joint infection, revision, and mechanical complications. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Riccardo Giai Via
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
| | - Francesco Bosco
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy.
- Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy.
| | - Francesco Onorato
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Davide Carlo Secco
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Fortunato Giustra
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | | | - Matteo Giachino
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Alessandro Massè
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| |
Collapse
|
3
|
Kebbach M, Schulze C, Meyenburg C, Kluess D, Sungu M, Hartmann A, Günther KP, Bader R. Do hip resurfacing and short hip stem arthroplasties differ from conventional hip stem replacement regarding impingement-free range of motion? J Orthop Res 2023; 41:2501-2515. [PMID: 37132090 DOI: 10.1002/jor.25584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/04/2023]
Abstract
Total hip joint replacement (THR) is clinically well-established. In this context, the resulting range of motion (ROM) is crucial for patient satisfaction when performing joint movements. However, the ROM for THR with different bone preserving strategies (short hip stem and hip resurfacing) raises the question of whether the ROM is comparable with conventional hip stems. Therefore, this computer-based study aimed to investigate the ROM and type of impingement for different implant systems. An established framework with computer-aided design 3D models based on magnetic resonance imaging data of 19 patients with hip osteoarthritis was used to analyse the ROM for three different implant systems (conventional hip stem vs. short hip stem vs. hip resurfacing) during typical joint movements. Our results revealed that all three designs led to mean maximum flexion higher than 110°. However, hip resurfacing showed less ROM (-5% against conventional and -6% against short hip stem). No significant differences were observed between the conventional and short hip stem during maximum flexion and internal rotation. Contrarily, a significant difference was detected between the conventional hip stem and hip resurfacing during internal rotation (p = 0.003). The ROM of the hip resurfacing was lower than the conventional and short hip stem during all three movements. Furthermore, hip resurfacing shifted the impingement type to implant-to-bone impingement compared with the other implant designs. The calculated ROMs of the implant systems achieved physiological levels during maximum flexion and internal rotation. However, bone impingement was more likely during internal rotation with increasing bone preservation. Despite the larger head diameter of hip resurfacing, the ROM examined was substantially lower than that of conventional and short hip stem.
Collapse
Affiliation(s)
- Maeruan Kebbach
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christian Schulze
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christian Meyenburg
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Daniel Kluess
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Mevluet Sungu
- Research and Development, Aesculap AG, Tuttlingen, Germany
| | - Albrecht Hartmann
- Department of Orthopedic Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- Department of Orthopedic Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| |
Collapse
|
4
|
Tung WS, Donnelley C, Pour AE, Tommasini S, Wiznia D. Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling. Bone Jt Open 2023; 4:416-423. [PMID: 37263587 PMCID: PMC10234721 DOI: 10.1302/2633-1462.46.bjo-2023-0046.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Aims Computer-assisted 3D preoperative planning software has the potential to improve postoperative stability in total hip arthroplasty (THA). Commonly, preoperative protocols simulate two functional positions (standing and relaxed sitting) but do not consider other common positions that may increase postoperative impingement and possible dislocation. This study investigates the feasibility of simulating commonly encountered positions, and positions with an increased risk of impingement, to lower postoperative impingement risk in a CT-based 3D model. Methods A robotic arm-assisted arthroplasty planning platform was used to investigate 11 patient positions. Data from 43 primary THAs were used for simulation. Sacral slope was retrieved from patient preoperative imaging, while angles of hip flexion/extension, hip external/internal rotation, and hip abduction/adduction for tested positions were derived from literature or estimated with a biomechanical model. The hip was placed in the described positions, and if impingement was detected by the software, inspection of the impingement type was performed. Results In flexion, an overall impingement rate of 2.3% was detected for flexed-seated, squatting, forward-bending, and criss-cross-sitting positions, and 4.7% for the ankle-over-knee position. In extension, most hips (60.5%) were found to impinge at or prior to 50° of external rotation (pivoting). Many of these impingement events were due to a prominent ischium. The mean maximum external rotation prior to impingement was 45.9° (15° to 80°) and 57.9° (20° to 90°) prior to prosthetic impingement. No impingement was found in standing, sitting, crossing ankles, seiza, and downward dog. Conclusion This study demonstrated that positions of daily living tested in a CT-based 3D model show high rates of impingement. Simulating additional positions through 3D modelling is a low-cost method of potentially improving outcomes without compromising patient safety. By incorporating CT-based 3D modelling of positions of daily living into routine preoperative protocols for THA, there is the potential to lower the risk of postoperative impingement events.
Collapse
Affiliation(s)
- Wei S. Tung
- Department of Orthopaedics & Rehabilitation, Yale University, New Haven, Connecticut, USA
| | - Claire Donnelley
- Department of Orthopaedics & Rehabilitation, Yale University, New Haven, Connecticut, USA
| | - Aidin E. Pour
- Department of Orthopaedics & Rehabilitation, Yale University, New Haven, Connecticut, USA
| | - Steven Tommasini
- Department of Orthopaedics & Rehabilitation, Yale University, New Haven, Connecticut, USA
| | - Daniel Wiznia
- Department of Orthopaedics & Rehabilitation, Yale University, New Haven, Connecticut, USA
| |
Collapse
|
5
|
Pour AE, Green JH, Christensen TH, Muthusamy N, Schwarzkopf R. Is It Necessary to Obtain Lateral Pelvic Radiographs in Flexed Seated Position for Preoperative Total Hip Arthroplasty Planning? Arthroplast Today 2023; 21:101133. [PMID: 37234599 PMCID: PMC10206860 DOI: 10.1016/j.artd.2023.101133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/06/2023] [Accepted: 03/08/2023] [Indexed: 05/28/2023] Open
Abstract
Background Many of the current total hip arthroplasty (THA) planning tools only consider sagittal pelvic tilt in the standing and relaxed sitting positions. Considering that the risk of postoperative dislocation is higher when bending forward or in sit-to-stand move, sagittal pelvic tilt in the flexed seated position may be more relevant for preoperative planning. We hypothesized that there was a significant difference in sagittal pelvic tilt between the relaxed sitting and flexed seated positions as measured by the sacral slope in preoperative and postoperative full-body radiographs. Methods This was a multicenter retrospective analysis of the preoperative and postoperative simultaneous biplanar full-body radiographs of 93 primary THA patients in standing, relaxed sitting, and flexed seated positions. The sagittal pelvic tilt was measured using the sacral slope relative to the horizontal line. Results The mean difference between the preoperative sacral slope in the relaxed sitting position and the flexed seated position was 11.3° (-13° to 43°) (P < .0001). This difference was >10° in 52 patients (56%) and >20° in 18 patients (19.4%). The mean difference between the postoperative sacral slope in a relaxed sitting position and the sacral slope in a flexed seated position was 11.3° (P < .0001). This difference was >10° in 51 patients (54.9%) and >30° in 14 patients (15.1%) postoperatively. Conclusions There was a significant difference in sagittal pelvic tilt between the relaxed and flexed seated positions. A flexed seated view provides valuable information that might be more relevant for preoperative THA planning in order to prevent postoperative THA instability.
Collapse
Affiliation(s)
- Aidin Eslam Pour
- Department of Orthopaedic Surgery, Yale University, New Haven, CT, USA
| | - Jordan H. Green
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Thomas H. Christensen
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Nishanth Muthusamy
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| |
Collapse
|
6
|
Pour AE, Green J, Christensen TH, Muthusamy N, Schwarzkopf R. The Current Proposed Total Hip Arthroplasty Surgical Planning Guidelines Based on Classification of Spine Stiffness May be Flawed Due to Incorrect Assumptions. J Arthroplasty 2023; 38:1075-1081. [PMID: 36863577 PMCID: PMC10200739 DOI: 10.1016/j.arth.2023.02.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The available classifications and preoperative planning tools for total hip arthroplasty assume that: 1) there is no variation in the sagittal pelvic tilt (SPT) if the radiographs are repeated, and 2) there is no significant change in the postoperative SPT postoperatively. We hypothesized that there would be significant differences in postoperative SPT tilt as measured by the sacral slope, thus rendering the current classifications and tools flawed. METHODS This study was a multicenter, retrospective analysis of preoperative and postoperative (1.5-6 months) full-body imaging of 237 primary total hip arthroplasty (standing and sitting positions). Patients were categorized as 1) stiff spine (standing sacral slope sitting sacral slope < 10°) and 2) normal spine (standing sacral slope-sitting sacral slope ≥ 10°). Results were compared using the paired t-test. The posthoc power analysis showed a power of 0.99. RESULTS The difference in mean standing and sitting sacral slope between the preoperative and postoperative measurements was 1°. However, in standing position, this difference was more than 10° in 14.4% of patients. In the sitting position, this difference was more than 10° in 34.2% of patients and more than 20° in 9.8% of patients. Postoperatively, 32.5% of patients switched groups based on the classification, which rendered the preoperative planning suggested by the current classifications flawed. CONCLUSION Current preoperative planning and classifications are based on a single acquisition of preoperative radiographs without the incorporation of possible postoperative changes in SPT. Validated classifications and planning tools should incorporate repeated measurements to determine the mean and variance in SPT and consider the significant postoperative changes in SPT.
Collapse
Affiliation(s)
- Aidin Eslam Pour
- Department of Orthopaedic Surgery, Yale University, New Haven, CT, USA
| | - Jordan Green
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Nishanth Muthusamy
- Department of Orthopaedic Surgery, New York University, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, New York University, New York, NY, USA
| |
Collapse
|
7
|
Chen M, Takahashi E, Kaneuji A, Tachi Y, Fukui M, Orita Y, Ichiseki T, Zhou Y, Kawahara N. Does the Dual Mobility Cup Reduce Dislocation After Primary Total Hip Arthroplasty in Elderly Patients at High Risk of Dislocation? Orthop Surg 2022; 15:496-501. [PMID: 36479825 PMCID: PMC9891910 DOI: 10.1111/os.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/27/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The dual mobility cup (DMC) is designed to extend the longevity of the prosthesis by improving stability, enhancing the range of motion, and decreasing impingement without increasing wear. We hypothesized that DMC would reduce the risk of dislocation in elderly patients. This study aimed to investigate the clinical and radiographic outcomes of DMC-total hip arthroplasty (THA) in elderly patients at high risk of dislocation. METHODS From June 2016 to March 2020, 94 patients with a mean age of 77.7 years (97 hips) who underwent a posterolateral approach for DMC-THA in our department were followed up for at least one year. Preoperative and postoperative pelvic tilt angles (PTA) and DMC orientation were prospectively collected for all patients. Intraoperative and postoperative complications were recorded. A parametric test was used for normal distribution, and a non-parametric test was used for non-normal distribution. RESULTS Abduction and anteversion angles of the cup were 42.4 and 18.0° in the supine position immediately postoperative. The average PTA for patients in the supine and standing positions were 26.5 and 34.5°, respectively. When moving from the supine to the standing position, patients experienced a mean posterior pelvic tilt of 9°. No intraoperative acetabular-related complications were recorded. Postoperative complications included early infection in one patient (1.0%) and dislocation in one patient (1.0%). CONCLUSION Our study demonstrates that DMC-THA provides satisfactory short-term outcomes in elderly patients at a high risk of dislocation, regardless of the change in PTA resulting from postural transition.
Collapse
Affiliation(s)
- Mingliang Chen
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan,Department of OrthopaedicsAffiliated Renhe Hospital of China Three Gorges UniversityYichangChina
| | - Eiji Takahashi
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Ayumi Kaneuji
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Yoshiyuki Tachi
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Makoto Fukui
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Yugo Orita
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Toru Ichiseki
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - You Zhou
- Department of OrthopaedicsAffiliated Renhe Hospital of China Three Gorges UniversityYichangChina
| | - Norio Kawahara
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| |
Collapse
|
8
|
Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging Strategy. J Clin Med 2022; 11:jcm11154416. [PMID: 35956033 PMCID: PMC9369831 DOI: 10.3390/jcm11154416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 12/04/2022] Open
Abstract
Hip arthroplasty (HA) is a frequently used procedure with high success rates, but 7% to 27% of the patients complain of persistent postsurgical pain 1 to 4 years post-operation. HA complications depend on the post-operative delay, the type of material used, the patient’s characteristics, and the surgical approach. Radiographs are still the first imaging modality used for routine follow-up, in asymptomatic and painful cases. CT and MRI used to suffer from metallic artifacts but are nowadays central in HA complications diagnosis, both having their advantages and drawbacks. Additionally, there is no consensus on the optimal imaging workup for HA complication diagnosis, which may have an impact on patient management. After a brief reminder about the different types of prostheses, this article reviews their normal and pathologic appearance, according to each imaging modality, keeping in mind that few abnormalities might be present, not anyone requiring treatment, depending on the clinical scenario. A diagnostic imaging workup is also discussed, to aid the therapist in his imaging studies prescription and the radiologist in their practical aspects.
Collapse
|