The value of contrast and subtraction arthrography in the assessment of aseptic loosening of total hip prostheses: a meta-analysis.
OBJECTIVE
To summarize and compare the diagnostic accuracy of contrast and subtraction arthrography in the assessment of aseptic loosening of total hip arthroplasties.


METHODS
This meta-analysis was performed using methods described by the Cochrane Methods Group on Systematic Reviews of Screening and Diagnostic Tests. We included original, English-language papers published between January 1975 to October 2004 that examined contrast-enhanced arthrography with or without subtraction for diagnosis of loosening of total hip prostheses. A qualitative and quantitative analysis was performed by two investigators.


RESULTS
With regard to the acetabular component, pooled sensitivity and specificity for contrast arthrography was 70% (95% confidence interval, 52-84) and 74% (95% CI, 53-87), respectively. Subtraction arthrography had a significantly higher sensitivity of 89% (95% CI, 84-93) (p=0.01), with a similar specificity of 76% (95% CI, 68-82). For the femoral component, pooled sensitivity and specificity for contrast arthrography were 63% (95% CI, 53-72) and 78% (95% CI, 68-86). Pooled estimates for subtraction arthrography revealed a significantly higher sensitivity of 86% (95% CI, 74-93) (p=0.003). Specificity was 85% (95% CI, 77-91) and was similar to the data of contrast arthrography (p=0.23).


CONCLUSIONS
Using the present data we found that the subtraction arthrography is a sensitive technique for detection of loosening of total hip prostheses, offering added value over contrast arthrography, especially for evaluation of the femoral component.
Temmerman
Olivier P P
OP
Department of Nuclear Medicine and PET Research, VU University Medical Centre, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands. opp.temmerman@vumc.nl
Heyligers
Ide C
IC
Teule
Gerrit J J
GJ
Hoekstra
Otto S
OS
Raijmakers
Pieter G H M
PG
D000328:Adult; D001175:Arthrography / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D003287:Contrast Media / Q000008:administration & dosage*; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006622:Hip Prosthesis; D006801:Humans; D011475:Prosthesis Failure; D012372:ROC Curve; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique
D003287:Contrast Media