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
Mistry JB et al: Trunnionosis in total hip arthroplasty: a review. J Orthop Traumatol. 17(1):1-6, 2016
Fritz J et al: MR imaging of hip arthroplasty implants. Radiographics. 34(4):E106-32, 2014
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
Pessis E et al: Virtual monochromatic spectral imaging with fast kilovoltage switching: reduction of metal artifacts at CT. Radiographics. 33(2):573-83, 2013
Chang EY et al: Metal-on-metal total hip arthroplasty: do symptoms correlate with MR imaging findings? Radiology. 265(3):848-57, 2012
Hayter CL et al: MRI findings in painful metal-on-metal hip arthroplasty. AJR Am J Roentgenol. 199(4):884-93, 2012
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
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
Roth TD et al: CT of the hip prosthesis: appearance of components, fixation, and complications. RadioGraphics. 32:1089-107, 2012
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
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
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
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
Ghelman B et al: CT outperforms radiography for determination of acetabular cup version after THA. Clin Orthop Relat Res. 467(9):2362-70, 2009
Glyn-Jones S et al: Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg Br. 91(12):1566-74, 2009
Hart AJ et al: The painful metal-on-metal hip resurfacing. J Bone Joint Surg Br. 91(6):738-44, 2009
Malviya A et al: Pseudotumours associated with metal-on-metal hip resurfacing: 10-year Newcastle experience. Acta Orthop Belg. 75(4):477-83, 2009
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
Choplin RH et al: Total hip arthroplasty in patients with bone deficiency of the acetabulum. Radiographics. 28(3):771-86, 2008
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
Pandit H et al: Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 90(7):847-51, 2008
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
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
Lindahl H: Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 38(6):651-4, 2007
Related Anatomy
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Related Differential Diagnoses
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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
Mistry JB et al: Trunnionosis in total hip arthroplasty: a review. J Orthop Traumatol. 17(1):1-6, 2016
Fritz J et al: MR imaging of hip arthroplasty implants. Radiographics. 34(4):E106-32, 2014
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
Pessis E et al: Virtual monochromatic spectral imaging with fast kilovoltage switching: reduction of metal artifacts at CT. Radiographics. 33(2):573-83, 2013
Chang EY et al: Metal-on-metal total hip arthroplasty: do symptoms correlate with MR imaging findings? Radiology. 265(3):848-57, 2012
Hayter CL et al: MRI findings in painful metal-on-metal hip arthroplasty. AJR Am J Roentgenol. 199(4):884-93, 2012
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
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
Roth TD et al: CT of the hip prosthesis: appearance of components, fixation, and complications. RadioGraphics. 32:1089-107, 2012
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
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
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
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
Ghelman B et al: CT outperforms radiography for determination of acetabular cup version after THA. Clin Orthop Relat Res. 467(9):2362-70, 2009
Glyn-Jones S et al: Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg Br. 91(12):1566-74, 2009
Hart AJ et al: The painful metal-on-metal hip resurfacing. J Bone Joint Surg Br. 91(6):738-44, 2009
Malviya A et al: Pseudotumours associated with metal-on-metal hip resurfacing: 10-year Newcastle experience. Acta Orthop Belg. 75(4):477-83, 2009
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
Choplin RH et al: Total hip arthroplasty in patients with bone deficiency of the acetabulum. Radiographics. 28(3):771-86, 2008
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
Pandit H et al: Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 90(7):847-51, 2008
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
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
Lindahl H: Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 38(6):651-4, 2007
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