1. Imaging of the Painful Hip Arthroplasty
Rikin Hargunani, MBBS, BSc, MRCS, FRCR, Hardi Madani, FRCR, Michael Khoo, BSc, MBBS, MRCP, FRCR, Anastasia Fotiadou, MD, PhD, Ian Pressney, MBBS, BSc, FRCR, Michele Calleja, MD, FRCR, Paul O'Donnell, FRCR, MRCP, (UK) MBBS 
Canadian Association of Radiologists Journal 
Volume 67, Issue 4, Pages (November 2016)
DOI: /j.carj
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2. Figure 1
Zonal anatomy of total hip arthroplasties: anteroposterior radiograph showing the 3 DeLee and Charnley zones (I-III) and also Gruen zones 1-7.
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3. Figure 2
Aseptic loosening: (A) lateral hip radiograph demonstrating mild circumferential periprosthetic lucency at the acetabulum as well as a more focal area (arrow), which demonstrated interval progression. (B) Coronal computed tomography (CT) reformatted image in another patient demonstrating extensive loosening around the acetabular (arrow) and femoral components following complex revision surgery. CT is beneficial in cases of marked protrusio acetabulae to aid preoperative planning by defining any medial wall cortical disruption as well as demonstrating adjacent vascular anatomy.
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4. Figure 3
Dislocation: anteroposterior radiograph demonstrating posterosuperior dislocation of the femur immediately following revision total hip arthroplasty, the commonest immediate complication. Note also a displaced reinforcement ring (arrow).
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5. Figure 4
Fractured greater trochanter and broken cerclage wires: anteroposterior radiograph following revision total hip arthroplasty showing displaced greater trochanteric fracture fragment in association with broken cerclage wires. Note also periprosthetic osteolysis at the acetabulum (zones I and II, arrowhead) and an angled and mildly displaced reinforcement ring (arrow).
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6. Figure 5
Intraoperative femoral fractures: anteroposterior radiograph obtained immediately postoperatively following revision total hip arthroplasty demonstrating 2 sites of femoral periprosthetic fracture (peritrochanteric and femoral stem). These fractures are commoner following revision arthroplasty and likely relate to the need for more extensive reaming of the femoral canal to accommodate longer stemmed components.
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7. Figure 6
Acetabular fracture: axial computed tomography image demonstrating a subtle medial acetabular periprosthetic fracture (arrow), which was not visible on plain radiographs.
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8. Figure 7
Periprosthetic infection: coronal short-time inversion recovery magnetic resonance image demonstrating a mature sinus tract with a low signal margin (arrow) extending from the right hip joint into the lateral soft tissues.
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9. Figure 8
Gluteal tendinopathy: axial T2-weighted magnetic resonance image demonstrating gluteus medius scarring and associated muscle atrophy (arrows) as well as gluteus minimus scarring and muscle atrophy (arrowheads). Note also the associated trochanteric bursal fluid collection.
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10. Figure 9
Iliopsoas bursal collection: axial T2-weighted magnetic resonance image demonstrating fluid distension of the iliopsoas bursa (arrowhead) adjacent to a slightly thickened distal iliopsoas tendon.
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11. Figure 10
Ischiofemoral impingement: axial T2-weighted magnetic resonance image demonstrating a reduced ischiofemoral distance, mild signal hyperintensity and reduced muscle bulk of quadratus femoris muscle (arrow) in a patient with clinical features of impingement.
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12. Figure 11
Heterotopic ossification: very extensive heterotopic ossification at the greater trochanter, which resulted in subilial mechanical soft tissue impingement.
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13. Figure 12
Particle wear: Lateral radiograph demonstrating asymmetric position of the femoral head within the acetabular component due to particle wear. Note also the extensive associated osteolysis surrounding the acetabular component.
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14. Figure 13
Bead shedding: anteroposterior radiograph of a revision hip arthroplasty with numerous punctate metallic densities projected over the periprosthetic soft tissues, not present on postoperative imaging obtained 2 years previously.
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15. Figure 14
Osteolysis: (A) axial T2-weighted fast-spin echo magnetic resonance image showing a partly solid and partly cystic pseudotumour (type 2b) arising anterior to the right femoral neck (arrowhead). A larger, more cystic appearing pseudotumour is identified lateral to the greater trochanter. A small focus of intermediate signal intensity osteolysis is just seen at the posterior femoral neck (arrow). (B) Axial computed tomography (CT) image of the right hip (same patient as in panel A) confirms osteolysis within the posterior aspect of the femoral neck (arrow) and also reveals very extensive osseous erosion of the anterior femoral cortex which was not appreciated on magnetic resonance imaging; the soft tissue pseudotumour (arrowhead) and trochanteric fluid collection are however less well characterized with CT. (C) Sagittal CT reformatted image in another patient demonstrating acetabular osteolysis (arrows), which was not seen on plain radiographs.
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16. Figure 15
Type 3 pseudotumour: axial T2 weighted magnetic resonance image demonstrating a bilobed, solid appearing pseudotumour (arrow), which returns low signal and extends into the pelvis.
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17. Figure 16
Metallosis: axial T2 weighted magnetic resonance image demonstrating extensive low signal foci representing macroscopic staining of the soft tissues surrounding the posterior aspect of the hip, extending laterally along the plane of surgical approach and also medially within the adductor compartment.
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18. Figure 17
Acetabular inclination: anteroposterior radiograph of a metal-on-metal bearing arthroplasty. The acetabular inclination is the angle it makes with the transischial line and in this case it is within the safe zone (40° ± 10°). There is also a radio-dense joint effusion (arrows), which was subsequently shown on magnetic resonance imaging to be small pseudotumour.
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