Download PDF
Rofo 2015; 187(07): 525-542
DOI: 10.1055/s-0034-1399232
Review
© Georg Thieme Verlag KG Stuttgart · New York

Modern Radiological Postoperative Diagnostics of the Hip Joint in Children and Adults

Moderne radiologische postoperative Diagnostik des Hüftgelenks im Kindes- und Erwachsenenalter
M.-A. Weber
1   Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
,
M. Egermann
2   Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
,
H. Thierjung
1   Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
,
J. K. Kloth
1   Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
› Author Affiliations
Further Information

Publication History

30 August 2014

17 January 2015

Publication Date:
06 March 2015 (online)

Also available at
   Permissions and Reprints

Abstract

The assessment of bone healing and loosening of endoprosthesis material was long the primary indication for postoperative projection radiography and CT imaging of the hip joint following trauma and endoprosthesis implantation. With the increasing number of joint-preserving surgery, e. g. of surgical hip luxation and hip arthroscopy for the treatment of femoroacetabular impingement (FAI), high-resolution imaging of intra-articular pathologies before and after surgery has become increasingly important. In this review article, diagnostic imaging of the hip joint is presented following common trauma surgery and orthopedic surgery interventions. The imaging modalities of projection radiography, CT and MRI including direct MR-arthrography are discussed with regard to their diagnostic capability in the postoperative assessment of the hip joint. Among others topics, imaging is discussed following hip arthroplasty, following surgical hip luxation and arthroscopic interventions for the treatment of FAI, as well as following core decompression for avascular necrosis of the femoral head. Moreover, orthopedic interventions of the hip joint in children and adolescents are presented and the dedicated reporting of postoperative imaging is outlined.

Key points:

• Consolidation of osteotomies and position of implants should be assessed in postoperative imaging.

• MRI is useful for confirming correct articulation after treatment of congenital hip dislocation.

• Radiologically assessable complications after total hip replacement are inlay wear, loosening, dislocation, periarticular ossifications and infection.

• MRI can detect and classify pseudotumours in cases of metal-metal pairing after total hip replacement.

Citation Format:

• Weber MA, Egermann M, Thierjung H et al. Modern Radiological Postoperative Diagnostics of the Hip Joint in Children and Adults. Fortschr Röntgenstr 2015; 187: 525 – 542

Zusammenfassung

Die Beurteilung von Knochenheilung und Implantatlockerung war über lange Zeit die Hauptindikation der postoperativen Röntgen- und CT-Bildgebung des Hüftgelenks nach Trauma und endoprothetischem Gelenkersatz. Mit zunehmender Zahl gelenkerhaltender Eingriffe, z. B. der chirurgischen Hüftluxation und der Hüftgelenkarthroskopie in der Therapie des femoroacetabulären Impingements (FAI) gewinnt die hochauflösende Diagnostik intraartikulärer Pathologien präoperativ wie auch in der postoperativen Bildgebung an Bedeutung. In dieser Übersicht wird die bildgebende Diagnostik des Hüftgelenks nach häufigen orthopädisch-unfallchirurgischen Eingriffen vorgestellt. Es werden die Modalitäten Projektionsradiografie, Computertomografie und Magnetresonanztomografie einschließlich der direkten MRT-Arthrografie hinsichtlich ihrer Wertigkeit in der postoperativen Diagnostik des Hüftgelenks diskutiert. Unter anderem werden die Befundinterpretation nach Hüftendoprothetik, nach chirurgischer Hüftluxation und arthroskopischer Operation bei FAI sowie nach Anbohrung einer Hüftkopfnekrose besprochen. Zudem werden kinderorthopädische Eingriffe am Hüftgelenk vorgestellt und deren dezidierte postoperative Bildbefundung skizziert.

Key words

hip joint - surgery - postoperative imaging - joint replacement - osteonecrosis - developmental dysplasia of the hip

Deutscher Artikel/German Article

 

  • References

  • 1 Funk JF, Lebek S. Epiphyseolysis capitis femoris. Neue Aspekte in Diagnostik und Therapie. Orthopäde 2014; 43: 742-749
    CrossrefPubMedGoogle Scholar
  • 2 Graf R. Radiologisch-orthopädische Anforderungsprofile bei der kindlichen Hüftdysplasie, der Koxitis und der Epiphyseolysis capitis femoris. Radiologe 2002; 42: 467-473
    CrossrefPubMedGoogle Scholar
  • 3 Breusch S, Mau H, Sabo D et al. Untere Extremität. In: Breusch S, Clarius M, Mau H. et al. (eds). Klinikleitfaden Orthopädie Unfallchirurgie. 7. Aufl. München: Elsevier; 2013: 429-562
    CrossrefGoogle Scholar
  • 4 Kramer J, Hofmann S, Scheurecker A et al. Morbus Perthes. Radiologe 2002; 42: 432-439
    CrossrefPubMedGoogle Scholar
  • 5 von Stillfried E, Weber MA. Aseptische Osteonekrosen bei Kindern und Jugendlichen. Orthopäde 2014; 43: 750-757
    CrossrefPubMedGoogle Scholar
  • 6 Multerer C, Döderlein L. Angeborene Hüftdysplasie und -luxation. Bewährte und neue Verfahren in Diagnostik und Therapie. Orthopäde 2014; 43: 733-741
    CrossrefPubMedGoogle Scholar
  • 7 Gould SW, Grissom LE, Niedzielski A et al. Protocol for MRI of the hips after spica cast placement. J Pediatr Orthop 2012; 32: 504-509
    CrossrefPubMedGoogle Scholar
  • 8 Steppacher SD, Tannast M, Siebenrock KA. Labrumläsionen des Hüftgelenks. Orthopädie und Unfallchirurgie up2date 2008; 3: 215-232
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Kramer J, Scheurecker G, Scheurecker A et al. Hüftkopfnekrose. Radiologe 2009; 49: 410-418
    CrossrefPubMedGoogle Scholar
  • 10 Mattes T, Fraitzl C, Ostertag O et al. Differentialdiagnosen der aseptischen Hüftkopfnekrose. Artikulärer Leistenschmerz des Erwachsenen. Orthopäde 2007; 36: 414-422
    CrossrefPubMedGoogle Scholar
  • 11 Carty FL, Cashman JP, Parvizi J et al. Imaging of the postoperative hip. Semin Musculoskelet Radiol 2011; 15: 357-371
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Fairbank AC, Bhatia D, Jinnah RH et al. Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg Br 1995; 77: 42-49
    PubMedGoogle Scholar
  • 13 Karantanas AH. Acute bone marrow edema of the hip: role of MR imaging. Eur Radiol 2007; 17: 2225-2236
    CrossrefPubMedGoogle Scholar
  • 14 Vande Berg BC, Lecouvet FE, Koutaissoff S et al. Bone marrow edema of the femoral head and transient osteoporosis of the hip. Eur J Radiol 2008; 67: 68-77
    CrossrefPubMedGoogle Scholar
  • 15 Mamisch TC, Werlen S, Zilkens C et al. Radiologische Diagnose des femoroacetabularen Impingements. Radiologe 2009; 49: 425-433
    CrossrefPubMedGoogle Scholar
  • 16 Reid GD, Reid CG, Widmer N et al. Femoroacetabular impingement syndrome: an underrecognized cause of hip pain and premature osteoarthritis?. J Rheumatol 2010; 37: 1395-1404
    CrossrefPubMedGoogle Scholar
  • 17 Räuchle M, Cemerka M, Eibenberger B et al. Arthrose – update 2012. Radiologe 2012; 52: 149-155
    CrossrefPubMedGoogle Scholar
  • 18 Czerny C, Oschatz E, Neuhold A et al. MR Arthrograpie des Hüftgelenkes. Radiologe 2002; 42: 451-456
    CrossrefPubMedGoogle Scholar
  • 19 Petersilge CA. MR arthrography for evaluation of the acetabular labrum. Skeletal Radiol 2001; 30: 423-430
    CrossrefPubMedGoogle Scholar
  • 20 Llopis E, Fernandez E, Cerezal L. MR and CT arthrography of the hip. Semin Musculoskelet Radiol 2012; 16: 42-56
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Nötzli HP, Wyss TF, Stoecklin CH et al. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 2002; 84: 556-560
    CrossrefPubMedGoogle Scholar
  • 22 Ganz R, Gill TJ, Gautier E et al. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 2001; 83: 1119-1124
    CrossrefPubMedGoogle Scholar
  • 23 Byrd JW. Hüftarthroskopie. Portaltechnik und arthroskopische Anatomie. Orthopäde 2006; 35: 41-53
    CrossrefPubMedGoogle Scholar
  • 24 Botser IB, Smith Jr TW, Nasser R et al. Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy 2011; 27: 270-278
    CrossrefPubMedGoogle Scholar
  • 25 Barron D. CT and MRI of hip arthroplasty. Clin Radiol 2007; 62: 1172-1173
    CrossrefPubMedGoogle Scholar
  • 26 Pfeil J, Höhle P, Rehbein P. Bilateraler endoprothetischer Ersatz am Hüft- oder Kniegelenk. Dtsch Arztebl Int 2011; 108: 463-468
    PubMedGoogle Scholar
  • 27 Richter-Kuhlmann EA. Hochschulmedizin: Balanceakt Indikationsstellung. Dtsch Arztebl 2013; 110: B-749
    PubMedGoogle Scholar
  • 28 Mayerhoefer ME, Fruhwald-Pallamar J, Czerny C. Bildgebung bei Hüftgelenkendoprothesen. Radiologe 2009; 49: 419-424
    CrossrefPubMedGoogle Scholar
  • 29 Miller TT. Imaging of hip arthroplasty. Eur J Radiol 2012; 81: 3802-3812
    CrossrefPubMedGoogle Scholar
  • 30 Hailer NP, Garellick G, Kärrholm J. Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register. Acta Orthop 2010; 81: 34-41
    CrossrefPubMedGoogle Scholar
  • 31 Azegami S, Gurusamy KS, Parker MJ. Cemented versus uncemented hemiarthroplasty for hip fractures: a systematic review of randomised controlled trials. Hip Int 2011; 21: 509-517
    CrossrefPubMedGoogle Scholar
  • 32 Abdulkarim A, Ellanti P, Motterlini N et al. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Orthop Rev (Pavia) 2013; 5: e8 DOI: 10.4081/or.2013.e8.
    CrossrefPubMedGoogle Scholar
  • 33 Duparc J (ed). Chirurgische Techniken in Orthopädie und Traumatologie. München: Urban & Fischer Verlag; 2005
    Google Scholar
  • 34 Hauptfleisch J, Pandit H, Grammatopoulos G et al. A MRI classification of periprosthetic soft tissue masses (pseudotumours) associated with metal-on-metal resurfacing hip arthroplasty. Skeletal Radiol 2012; 41: 149-155
    CrossrefPubMedGoogle Scholar
  • 35 Parsons TM, Satchithananda K, Berber R et al. Magnetresonanztomographische Untersuchungen bei Problemen mit Metall-auf-Metall-Implantaten. Orthopäde 2013; 42: 629-636
    CrossrefPubMedGoogle Scholar
  • 36 Cahir JG, Toms AP, Marshall TJ et al. CT and MRI of hip arthroplasty. Clin Radiol 2007; 62: 1163-1171
    CrossrefPubMedGoogle Scholar
  • 37 Jesse MK, Petersen B, Strickland C et al. Normal anatomy and imaging of the hip: emphasis on impingement assessment. Semin Musculoskelet Radiol 2013; 17: 229-247
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Tschauner C, Fock CM, Hofmann S et al. Rotationsfehler des Hüftgelenks. Radiologe 2002; 42: 457-466
    CrossrefPubMedGoogle Scholar
  • 39 Pradhan R. Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs. J Bone Joint Surg Br 1999; 81: 431-435
    CrossrefPubMedGoogle Scholar
  • 40 Agten CA, Sutter R, Pfirrmann CWA. CT und MRT der Hüftprothese. Radiologe 2014; 54: 715-726
    CrossrefPubMedGoogle Scholar
  • 41 Hendrich C, Sauer U, Albrecht T et al. Subsidence of titanium straight stems in combination with highly viscous bone cement. Int Orthop 2005; 29: 96-100
    CrossrefPubMedGoogle Scholar
  • 42 Hayter CL, Koff MF, Potter HG. Magnetic resonance imaging of the postoperative hip. J Magn Reson Imaging 2012; 35: 1013-1025
    CrossrefPubMedGoogle Scholar
  • 43 Ostlere S. How to image metal-on-metal prostheses and their complications. Am J Roentgenol 2011; 197: 558-567
    CrossrefPubMedGoogle Scholar
  • 44 Brooker AF, Bowerman JW, Robinson RA et al. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 1973; 55: 1629-1632
    CrossrefPubMedGoogle Scholar
  • 45 Kidoh M, Nakaura T, Nakamura S et al. Reduction of dental metallic artefacts in CT: value of a newly developed algorithm for metal artefact reduction (O-MAR). Clin Radiol 2014; 69: e11-e16
    CrossrefPubMedGoogle Scholar