Digital subtraction arthrography in preoperative evaluation of painful total hip arthroplasty.
OBJECTIVE
The objective of this clinical study was to define the diagnostic value of plain radiography, digital subtraction arthrography and two-phase bone scintigraphy in patients with clinically loose or infected hip prostheses.


METHODS
Digital subtraction arthrograms, scintigrams and plain radiographs of 70 consecutive patients who underwent revision hip arthroplasty were scored individually and in masked fashion for the presence or absence of features indicating loosening of femoral and/or acetabular components. The operative findings acted as the gold standard.


RESULTS
Digital subtraction arthrography was best (P < 0.001) for predicting a loose acetabular component, while no significant additional predictive value was found for plain radiographs (P = 0.24) and scintigraphy (P = 0.27). Digital subtraction arthrography was also the most important modality for predicting a loose femoral component (P = 0.001), while the plain radiograph was of significant (P = 0.04) additional value and scintigraphy was of no additional value (P = 0.13) on multivariate analysis.


CONCLUSIONS
Digital subtraction arthrography gives the best results in the prediction of loosening of acetabular and femoral components. Plain radiographs give additional information on loosening of the femoral component, but scintigraphy offers no additional advantage.
Ginai
A Z
AZ
Department of Radiology, University Hospital Dijkzigt Rotterdam, The Netherlands.
van Biezen
F C
FC
Kint
P A
PA
Oei
H Y
HY
Hop
W C
WC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D011475:Prosthesis Failure; D011856:Radiographic Image Enhancement; D011877:Radionuclide Imaging; D012086:Reoperation; D013382:Subtraction Technique