An Update on Imaging of Joint Reconstructions

One of the most bread-and-butter aspects of musculoskeletal radiology is imaging of joint replacements or arthroplasties. I have always found it interesting that the orthopaedic surgeons refer to this as reconstructive surgery but this is a term sparsely used in a radiology literature. I compliment Ted Miller for using that term in the title of this issue. The most commonly performed arthroplasties are hips and knees, which are covered in excellent detail by Dr. Miller, Dr. Math, et al. Also importantly emphasized are the joint arthroplasties that may be less familiar to practicing radiologists. The eminent Dr. Freda Feldman handles shoulder replacements, and there is one section on the newest arthroplasties, that of lumbar discs, by Dr. Petersilge. The latter is likely to become one of the most commonly performed orthopaedic surgeries in the next decade, and it behooves practicing radiologist to learn more of the cutting edge technique. The articulations are rounded out by Dr. Lecomte et al. discussing small joint arthroplasties.

However, in keeping with the detail and innovation, musculoskeletal imager Ted Miller rounds out this issue with three chapters that fulfill these adjectives. The first is written by himself concerning ultrasonography of replacements. In the second, Ken Buckwalter discusses multiple channel CT imaging of orthopaedic hardware. Multidetector CT has most notably been an advance in abdominal imaging as well as vascular imaging. Its use in the musculoskeletal system in the past few years has been somewhat overlooked, although it has had tremendous import in the evaluation of trauma patients. What many of us have realized is the multislice capabilities have advanced so that true isotopic imaging is now obtained without overwhelming radiation doses, with consequence reduction of artifacts. Dr. Buckwalter has been a pioneer in this field. The issue's last article is by Drs. Naraghi and White on MR imaging of joint replacements. This is becoming a more commonly done procedure, most notably to evaluate areas around the arthroplasty but interestingly and increasingly for visualization around the arthroplasties. Larry White has been in the vanguard in optimizing images around arthroplasties.

This is a topic that is presented in an exceedingly advanced way. There is some covering of the basics. There is some covering of what every radiologist needs to know. Most important, there are detailed descriptions not only of what radiologists need to know but perhaps also of what we don't know as well as we should. Lastly, the issue is rounded out by advanced imaging of arthroplasties by modalities that will be increasingly used in the future. Ted is a long-time and well-respected friend of both David and I, and he has a fairly unique practice environment where he is able to use several modalities on the same patient at the same time. This gives him unique insight into disorders of articulations rather than the typical tunnel vision modality-based interpretation that many of us have, including myself. The end result of Ted's understanding of these disorders and consequently how it appears in multiple different modalities is a truly exquisite issue, and we compliment again him for it.