From the RSNA refresher courses. Total hip arthroplasty: radiographic evaluation

Abstract

Expected appearances of total hip arthroplasty vary according to type of implant, its method of fixation (cemented, porous coating for bone ingrowth, press fit), and whether it is a revision. Cemented arthroplastic components normally may show 1-2-mm-wide radiolucent zones at cement interfaces. Definite loosening is diagnosed when progressive widening of the radiolucent zone, migration of a cemented component, or change in alignment is seen. In cementless arthroplasty, normal findings include calcar resorption, radiolucent zones up to 2 mm in width, cortical thickening, periosteal reaction, endosteal sclerosis, and even subsidence of the femoral component that stabilizes at less than 1 cm. The most reliable radiographic signs of loosening in cementless arthroplasty are progressive subsidence, migration, or tilt of the component. Because subsidence or change in alignment may be very subtle, serial radiography and measurement are often required for diagnosis. Other signs that indicate loosening include bead shedding (in porous-coated prostheses), extensive cortical hypertrophy, endosteal bone bridging at the stem tip, endosteal scalloping, and a radiolucent zone wider than 2 mm. In revision arthroplasty, wide radiolucent zones and subsidence are common. The diagnosis of revision failure is based on progressive widening of the radiolucent zones and change in component position after 12 months.