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

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Definitions

          • Revision arthroplasty: placement of new component(s) following removal of failed prosthesis/component
            • Wide spectrum of revision
              • Small changes may not be obvious
                • Exchange of polyethylene component
                • Change of femoral head (modular; may be changed without extracting stem)
              • Larger changes of entire components
            • Some revisions have implications related to substantial bone loss: large defects to fill, little bone to support implant
              • Loose components may fracture and erode large regions of bone
              • Infection may destroy bone
              • Small particle disease with massive osteolysis leaves bone defects
            • Imaging evaluation required both pre- and postoperatively
              • Preoperative: evaluation of bone stock for surgical planning
              • Postoperative: evaluation for complications
          • Arthroplasty = name for procedure (surgery), not for device (prosthesis/implant)

        IMAGING

        • Radiographic Findings

          • CT Findings

            • MR Findings

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • Staging, Grading, & Classification

                  CLINICAL ISSUES

                  • Demographics

                    • Natural History & Prognosis

                      DIAGNOSTIC CHECKLIST

                      • Consider

                        Selected References

                        1. Sculco PK et al: The diagnosis and treatment of acetabular bone loss in revision hip arthroplasty: an international consensus symposium. HSS J. 18(1):8-41, 2022
                        2. Rath B et al: [Revision total hip arthroplasty: significance of instability, impingement, offset and gluteal insufficiency.] Orthopade. 48(4):315-21, 2019
                        3. Schmolders J et al: Validation of the Charlson comorbidity index in patients undergoing revision total hip arthroplasty. Int Orthop. 39(9):1771-7, 2015
                        4. 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
                        5. Symeonides PP et al: The effectiveness of the Burch-Schneider antiprotrusio cage for acetabular bone deficiency: five to twenty-one years' follow-up. J Arthroplasty. 24(2):168-74, 2009
                        6. Williams D et al: Revision arthroplasty: an update. Skeletal Radiol. 38(11):1031-6, 2009
                        7. Choplin RH et al: Total hip arthroplasty in patients with bone deficiency of the acetabulum. Radiographics. 28(3):771-86, 2008
                        8. Ogawa H et al: Morcellized bone grafting for acetabular deficiency in cementless total hip arthroplasty. Orthopedics. 31(10), 2008
                        Related Anatomy
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                        Related Differential Diagnoses
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                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Terminology

                          • Imaging

                            • Diagnostic Checklist

                              TERMINOLOGY

                              • Definitions

                                • Revision arthroplasty: placement of new component(s) following removal of failed prosthesis/component
                                  • Wide spectrum of revision
                                    • Small changes may not be obvious
                                      • Exchange of polyethylene component
                                      • Change of femoral head (modular; may be changed without extracting stem)
                                    • Larger changes of entire components
                                  • Some revisions have implications related to substantial bone loss: large defects to fill, little bone to support implant
                                    • Loose components may fracture and erode large regions of bone
                                    • Infection may destroy bone
                                    • Small particle disease with massive osteolysis leaves bone defects
                                  • Imaging evaluation required both pre- and postoperatively
                                    • Preoperative: evaluation of bone stock for surgical planning
                                    • Postoperative: evaluation for complications
                                • Arthroplasty = name for procedure (surgery), not for device (prosthesis/implant)

                              IMAGING

                              • Radiographic Findings

                                • CT Findings

                                  • MR Findings

                                    DIFFERENTIAL DIAGNOSIS

                                      PATHOLOGY

                                      • Staging, Grading, & Classification

                                        CLINICAL ISSUES

                                        • Demographics

                                          • Natural History & Prognosis

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              Selected References

                                              1. Sculco PK et al: The diagnosis and treatment of acetabular bone loss in revision hip arthroplasty: an international consensus symposium. HSS J. 18(1):8-41, 2022
                                              2. Rath B et al: [Revision total hip arthroplasty: significance of instability, impingement, offset and gluteal insufficiency.] Orthopade. 48(4):315-21, 2019
                                              3. Schmolders J et al: Validation of the Charlson comorbidity index in patients undergoing revision total hip arthroplasty. Int Orthop. 39(9):1771-7, 2015
                                              4. 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
                                              5. Symeonides PP et al: The effectiveness of the Burch-Schneider antiprotrusio cage for acetabular bone deficiency: five to twenty-one years' follow-up. J Arthroplasty. 24(2):168-74, 2009
                                              6. Williams D et al: Revision arthroplasty: an update. Skeletal Radiol. 38(11):1031-6, 2009
                                              7. Choplin RH et al: Total hip arthroplasty in patients with bone deficiency of the acetabulum. Radiographics. 28(3):771-86, 2008
                                              8. Ogawa H et al: Morcellized bone grafting for acetabular deficiency in cementless total hip arthroplasty. Orthopedics. 31(10), 2008