Hip Pelvis.  2015 Jun;27(2):90-97. 10.5371/hp.2015.27.2.90.

The Usefulness of Three-dimensional Computed Tomography as an Assessment of Periacetabular Osteolysis in Revision Total Hip Arthroplasty

Affiliations
  • 1Department of Orthopedic Surgery, Inha University School of Medicine, Incheon, Korea. moon@inha.ac.kr

Abstract

PURPOSE
This study was performed to determine the usefulness of three-dimensional computed tomography (3D-CT) in measuring periacetabular osteolysis by comparing the real volume of osteolysis in revision surgery.
MATERIALS AND METHODS
Twnety-three patients who had undergone revision surgery due to periacetabular osteolysis but not included septic osteolysis and implant loosening. The mean age of patients at the time of surgery was 55.2 years. And the mean time interval between the primary total hip arthroplasty and revision surgery was 13.3 years. We measured the polyethylene wear in plain radiographs using computer assisted vector wear analysis program, the volume of acetabular osteolytic lesions in high-resolution spiral CT scans using Rapidia 3D software version 2.8 algorithms before the revision surgery were performed. Intraoperative real osteolytic volume was calculated as the sum of the volumetric increments of the acetabular cup and impacted allo-cancellous bone volume.
RESULTS
Strong correlation was found between the volume of acetabular osteolytic lesions measured on 3D-CT and intraoperative real osteolytic volume which was calculated as the sum of the volumetric increments of the acetabular cup and impacted allo-cancellous bone volume.
CONCLUSION
3D-CT is considered a useful method for assessing and measuring the volume of periacetabular osteolysis before revision surgery.

Keyword

Computed tomography; Osteolysis; Arthroplasty

MeSH Terms

Acetabulum
Arthroplasty
Arthroplasty, Replacement, Hip*
Humans
Methods
Osteolysis*
Polyethylene
Tomography, Spiral Computed
Polyethylene

Figure

  • Fig. 1 This figure shows periacetabular osteolysis after primary total hip replacement arthroplasty in avascular necrosis of the right hip and measurement of osteolysis by computer assisted vector wear analysis program and three-dimentional (3D) computed tomography in a 56 years old man. (A) This immediate postoperative anteroposterior plain radiography shows good positioning of the prosthesis (May 2001). (B) After 10 years (May 2011), the plain radiography shows periacetabular osteolytic lesion (arrow). (C, D) The images were analyzed by applying a computer assisted vector wear analysis program (University of Chicago, hip analysis program 4.0). (E) We measured the volume of acetabular ostelytic lesions via high-resolution spiral computed tomography scans. (F) We reconstructed to a 3D ostelytic volume by using via Rapidia 3D software version 2.8.

  • Fig. 2 A weak correlation was found between the mean linear wear rate of polyethylene liners measured on plain radiographs and osteolytic volumes measured on three-dimensional computed tomography (3D-CT) with no statistically significance (r2=0.18 , P=0.938).

  • Fig. 3 The correlation between the mean linear and volumetric wear rate of polyethylene liners was weak with no statistically significance (r2=0.206, P=0.359).

  • Fig. 4 A strong and significant relationship was found between osteolytic volume measured on the three-dimensional computed tomography and the sum of the volumetric increments of acetabular cups and impacted allo-cancellous bone volume with a statistical significance (r2=0.773, P<0.001).

  • Fig. 5 The realationship between sum of the volumetric increments of acetabular cup and impacted allocancellous bone volume and osteolytic volume measured on three-dimensional computed tomography (3D-CT) (r=0.773, P<0.001). a: radius of acetabular wall, b: radius of acetabular cup, c: osteolytic volume measured on 3D-CT, c': grafted allo-cancellous bone volume.


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