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Hip Implant
Jonelle M. Petscavage-Thomas, MD, MPH; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Total hip arthroplasty (THA)/total hip replacement (THR): replacement of both acetabulum and femoral head (and neck)
        • Hemiarthroplasty or endoprosthesis: replacement of femoral head only
          • Used in osteonecrosis or displaced subcapital fracture without associated arthritis of hip
        • Hip resurfacing: replacement of surface of femoral head, retaining stump of head, with short stem or peg
          • Used in younger patient population
          • Theoretically maximizes THA life available to patient by maintaining bone stock, allowing revision to standard THA
        • Arthroplasty = name for procedure (surgery), not for device (prosthesis/implant)
      • Components/Materials

        • Modern femoral component usually modular: multiple parts assembled into one
        • Current materials include titanium, cobalt-chromium, ceramic (femoral head only), high-molecular-weight polyethylene ("poly" → insert for acetabular cup)

      IMAGING

      • Radiographic Findings

        • CT Findings

          • MR Findings

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  • Staging, Grading, & Classification

                    • Microscopic Features

                      • Reasons for Revision Arthroplasty

                        CLINICAL ISSUES

                        • Demographics

                          • Natural History & Prognosis

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                Selected References

                                1. Mistry JB et al: Trunnionosis in total hip arthroplasty: a review. J Orthop Traumatol. 17(1):1-6, 2016
                                2. Fritz J et al: MR imaging of hip arthroplasty implants. Radiographics. 34(4):E106-32, 2014
                                3. Awan O et al: Imaging evaluation of complications of hip arthroplasty: review of current concepts and imaging findings. Can Assoc Radiol J. 64(4):306-13, 2013
                                4. Pessis E et al: Virtual monochromatic spectral imaging with fast kilovoltage switching: reduction of metal artifacts at CT. Radiographics. 33(2):573-83, 2013
                                5. Chang EY et al: Metal-on-metal total hip arthroplasty: do symptoms correlate with MR imaging findings? Radiology. 265(3):848-57, 2012
                                6. Hayter CL et al: MRI findings in painful metal-on-metal hip arthroplasty. AJR Am J Roentgenol. 199(4):884-93, 2012
                                7. Mulcahy H et al: Current concepts of hip arthroplasty for radiologists: part 1, features and radiographic assessment. AJR Am J Roentgenol. 199(3):559-69, 2012
                                8. Mulcahy H et al: Current concepts of hip arthroplasty for radiologists: part 2, revisions and complications. AJR Am J Roentgenol. 199(3):570-80, 2012
                                9. Roth TD et al: CT of the hip prosthesis: appearance of components, fixation, and complications. RadioGraphics. 32:1089-107, 2012
                                10. Yanny S et al: MRI of aseptic lymphocytic vasculitis-associated lesions in metal-on-metal hip replacements. AJR Am J Roentgenol. 198(6):1394-402, 2012
                                11. Bozic KJ et al: The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 91(1):128-33, 2009
                                12. Dorr LD et al: A comparison of surgeon estimation and computed tomographic measurement of femoral component anteversion in cementless total hip arthroplasty. J Bone Joint Surg Am. 91(11):2598-604, 2009
                                13. Eswaramoorthy VK et al: Clinical and radiological outcome of stemmed hip replacement after revision from metal-on-metal resurfacing. J Bone Joint Surg Br. 91(11):1454-8, 2009
                                14. Ghelman B et al: CT outperforms radiography for determination of acetabular cup version after THA. Clin Orthop Relat Res. 467(9):2362-70, 2009
                                15. Glyn-Jones S et al: Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg Br. 91(12):1566-74, 2009
                                16. Hart AJ et al: The painful metal-on-metal hip resurfacing. J Bone Joint Surg Br. 91(6):738-44, 2009
                                17. Malviya A et al: Pseudotumours associated with metal-on-metal hip resurfacing: 10-year Newcastle experience. Acta Orthop Belg. 75(4):477-83, 2009
                                18. Ollivere B et al: The continued value of clinical and radiological surveillance: the Charnley Elite Plus hip replacement system at 12 years. J Bone Joint Surg Br. 2009 Jun;91(6):720-4. Erratum in: J Bone Joint Surg Br. 91(8):1120, 2009
                                19. Choplin RH et al: Total hip arthroplasty in patients with bone deficiency of the acetabulum. Radiographics. 28(3):771-86, 2008
                                20. De Haan R et al: Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br. 90(10):1291-7, 2008
                                21. Pandit H et al: Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 90(7):847-51, 2008
                                22. Toms AP et al: MRI of early symptomatic metal-on-metal total hip arthroplasty: a retrospective review of radiological findings in 20 hips. Clin Radiol. 63(1):49-58, 2008
                                23. Utting MR et al: The Harris-Galante porous-coated, hemispherical, polyethylene-lined acetabular component in patients under 50 years of age: a 12- to 16-year review. J Bone Joint Surg Br. 90(11):1422-7, 2008
                                24. Lindahl H: Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 38(6):651-4, 2007
                                Related Anatomy
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    TERMINOLOGY

                                    • Definitions

                                      • Total hip arthroplasty (THA)/total hip replacement (THR): replacement of both acetabulum and femoral head (and neck)
                                      • Hemiarthroplasty or endoprosthesis: replacement of femoral head only
                                        • Used in osteonecrosis or displaced subcapital fracture without associated arthritis of hip
                                      • Hip resurfacing: replacement of surface of femoral head, retaining stump of head, with short stem or peg
                                        • Used in younger patient population
                                        • Theoretically maximizes THA life available to patient by maintaining bone stock, allowing revision to standard THA
                                      • Arthroplasty = name for procedure (surgery), not for device (prosthesis/implant)
                                    • Components/Materials

                                      • Modern femoral component usually modular: multiple parts assembled into one
                                      • Current materials include titanium, cobalt-chromium, ceramic (femoral head only), high-molecular-weight polyethylene ("poly" → insert for acetabular cup)

                                    IMAGING

                                    • Radiographic Findings

                                      • CT Findings

                                        • MR Findings

                                          • Imaging Recommendations

                                            DIFFERENTIAL DIAGNOSIS

                                              PATHOLOGY

                                              • General Features

                                                • Staging, Grading, & Classification

                                                  • Microscopic Features

                                                    • Reasons for Revision Arthroplasty

                                                      CLINICAL ISSUES

                                                      • Demographics

                                                        • Natural History & Prognosis

                                                          DIAGNOSTIC CHECKLIST

                                                          • Consider

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Mistry JB et al: Trunnionosis in total hip arthroplasty: a review. J Orthop Traumatol. 17(1):1-6, 2016
                                                              2. Fritz J et al: MR imaging of hip arthroplasty implants. Radiographics. 34(4):E106-32, 2014
                                                              3. Awan O et al: Imaging evaluation of complications of hip arthroplasty: review of current concepts and imaging findings. Can Assoc Radiol J. 64(4):306-13, 2013
                                                              4. Pessis E et al: Virtual monochromatic spectral imaging with fast kilovoltage switching: reduction of metal artifacts at CT. Radiographics. 33(2):573-83, 2013
                                                              5. Chang EY et al: Metal-on-metal total hip arthroplasty: do symptoms correlate with MR imaging findings? Radiology. 265(3):848-57, 2012
                                                              6. Hayter CL et al: MRI findings in painful metal-on-metal hip arthroplasty. AJR Am J Roentgenol. 199(4):884-93, 2012
                                                              7. Mulcahy H et al: Current concepts of hip arthroplasty for radiologists: part 1, features and radiographic assessment. AJR Am J Roentgenol. 199(3):559-69, 2012
                                                              8. Mulcahy H et al: Current concepts of hip arthroplasty for radiologists: part 2, revisions and complications. AJR Am J Roentgenol. 199(3):570-80, 2012
                                                              9. Roth TD et al: CT of the hip prosthesis: appearance of components, fixation, and complications. RadioGraphics. 32:1089-107, 2012
                                                              10. Yanny S et al: MRI of aseptic lymphocytic vasculitis-associated lesions in metal-on-metal hip replacements. AJR Am J Roentgenol. 198(6):1394-402, 2012
                                                              11. Bozic KJ et al: The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 91(1):128-33, 2009
                                                              12. Dorr LD et al: A comparison of surgeon estimation and computed tomographic measurement of femoral component anteversion in cementless total hip arthroplasty. J Bone Joint Surg Am. 91(11):2598-604, 2009
                                                              13. Eswaramoorthy VK et al: Clinical and radiological outcome of stemmed hip replacement after revision from metal-on-metal resurfacing. J Bone Joint Surg Br. 91(11):1454-8, 2009
                                                              14. Ghelman B et al: CT outperforms radiography for determination of acetabular cup version after THA. Clin Orthop Relat Res. 467(9):2362-70, 2009
                                                              15. Glyn-Jones S et al: Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg Br. 91(12):1566-74, 2009
                                                              16. Hart AJ et al: The painful metal-on-metal hip resurfacing. J Bone Joint Surg Br. 91(6):738-44, 2009
                                                              17. Malviya A et al: Pseudotumours associated with metal-on-metal hip resurfacing: 10-year Newcastle experience. Acta Orthop Belg. 75(4):477-83, 2009
                                                              18. Ollivere B et al: The continued value of clinical and radiological surveillance: the Charnley Elite Plus hip replacement system at 12 years. J Bone Joint Surg Br. 2009 Jun;91(6):720-4. Erratum in: J Bone Joint Surg Br. 91(8):1120, 2009
                                                              19. Choplin RH et al: Total hip arthroplasty in patients with bone deficiency of the acetabulum. Radiographics. 28(3):771-86, 2008
                                                              20. De Haan R et al: Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br. 90(10):1291-7, 2008
                                                              21. Pandit H et al: Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 90(7):847-51, 2008
                                                              22. Toms AP et al: MRI of early symptomatic metal-on-metal total hip arthroplasty: a retrospective review of radiological findings in 20 hips. Clin Radiol. 63(1):49-58, 2008
                                                              23. Utting MR et al: The Harris-Galante porous-coated, hemispherical, polyethylene-lined acetabular component in patients under 50 years of age: a 12- to 16-year review. J Bone Joint Surg Br. 90(11):1422-7, 2008
                                                              24. Lindahl H: Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 38(6):651-4, 2007