can you have a ct scan with a hip replacement

Table 3 Reconstruction Parameters for Multidetector CT of Hip Implants. Also, the wear rate and types of complications vary with different bearing surfaces (20–25). The metal from hip implant hardware produces streak artifact and other artifacts on CT scans, thereby adversely affecting image quality. Coronal reformatted CT image shows bone in-growth and “spot welding” of the uncemented femoral stem (black arrow). Dual-energy CT techniques have also shown promise for metal artifact reduction. (c) What are the bearing surfaces? The areas of bone in-growth (also called struts or “spot welds”) are recognized on radiographs and CT scans by the presence of trabecular bone that extends all the way to the metal component surface (Fig 10).Figure 10 Solid fixation from bone in-growth in a patient with a right total hip prosthesis. Sagittal reformatted CT image shows a metal fatigue fracture of the femoral stem (solid arrow). Note also the stress shielding (white arrows), which is responsible for the relative hypoattenuation and overall decrease in bone mass in these regions. Cement (usually polymethylmethacrylate) is used to fill the spaces between the bone and hardware, creating a “mantle” around the hardware that produces a uniform fit with evenly distributed forces. From the Department of Radiology and Imaging Sciences (T.D.R., N.A.M., K.A.B., R.H.C.) Multidetector computed tomography (CT) is an excellent way to supplement the radiographic evaluation of problematic hip prostheses. The resurfacing type implant has a relatively small acetabular cup (note the slight step-off of the acetabular cup and femoral head [black arrow in a]). Note that there is no corresponding offset of the adjacent femoral cortex, which helps distinguish the fracture from a misregistration artifact due to patient motion. has disclosed a financial relationship (see “Disclosures of Potential Conflicts of Interest”); all other authors, the editor, and reviewers have no relevant relationships to disclose. The components of a total hip prosthesis include the acetabular cup, the femoral head, and the femoral stem. You can find more information on the complexity of hip-spine in our article: Hip-spine syndrome can lead to failed hip replacement and lumbar spinal fusion complication. Figure 11 Normal low-attenuation areas. Having an MRI scan with a metal implant can be fatal due to the magnetic field But as most knee and hip implants are made of titanium, this is rarely a concern By Martin Scurr for the Daily Mail You went in for a hip surgery. Note also the bearing surfaces in Figures 2, 3b, and 7: metal-on-cartilage (Fig 2a), metal-on-polyethylene and metal-on-cartilage (Fig 2b), metal-on-polyethylene (Fig 3b), and ceramic-on-ceramic (Fig 7). (c) Total hip prosthesis with a cemented acetabular cup (arrow). 11, 1 August 2013 | Der Orthopäde, Vol. Fractures of the cement mantle and anterior cortex are also seen more superiorly (open arrow). Multidetector CT is an excellent supplemental imaging tool for evaluating a hip prosthesis (note that although some investigators prefer the term multichannel, multidetector is the more commonly used term). Prostheses are fixed to bone to prevent unwanted movement. 6, Journal of Computer Assisted Tomography, Vol. So again, you went and had an MRI of your hip. On the femoral side, fractures, bone loss at the proximal femur (ie, the calcar), and loss of the normal diaphyseal tapering are important for surgical planning. 58, No. 5, Journal of Computer Assisted Tomography, Vol. A 501(c)(3) non-profit organization, Accreditation: A National Seal of Quality and Safety, Imaging Patient Satisfaction Survey Results, Adler/Nail and Cedars-Sinai Research for Women's Cancers P.E.T. Table 1 Factors Affecting Metal Artifacts at Multidetector CT. 38, No. There is no consensus among orthopedic surgeons regarding optimal arthroplasty technique, implant material and design, and methods of fixation for primary hip reconstruction. 67, No. Arthrography can be performed in conjunction with CT to evaluate periprosthetic fluid collections. The S. Mark Taper Foundation Imaging Center provides a full range of advanced imaging, both radiology and cardiology, as well as interventional radiology and interventional tumor (oncology) treatments to the greater Los Angeles area, including Beverly Hills, Encino, Mid-Cities, Sherman Oaks, Silver Lake, Studio City, Toluca Lake and West Hollywood. The imaging assessment is done primarily with radiographs (28–30), but the same basic principles of assessing and measuring the position of the implant can be applied to CT scans. 2, Journal of Biomedical Science and Engineering, Vol. (b) Corresponding CT scan shows greater streak artifact from the more dense cobalt-chrome component than from the less dense titanium component. Misplaced screw in a patient who experienced severe radicular left leg pain following total hip replacement. Multidetector CT is an excellent supplement to radiography for the imaging evaluation of a reconstructed hip. All Rights Reserved. Radiography is also the initial imaging modality of choice for evaluating symptomatic hip implants for potential complications. The native acetabular cartilage and subchondral bone plate are preserved during hemiarthroplasty, and they can often be recognized on coronal reformatted CT images of a hemiprosthesis (Figs 2, 3). IMHO all patients who are considering hip replacement surgery need at least a pre – hip replacement MRI (which provides some additional information that at least correlates with pain) and a diagnostic numbing injection into the hip … In any case, surgeons want to avoid liner erosion that allows contact between the head and the metal shell. Yes … Attenuation of different metals in a patient with bilateral total hip prostheses. We perform the majority of our CT examinations of prosthetic hips without the use of contrast material. Periprosthetic bone is clearly depicted with modern multidetector CT images that have been optimized to reduce metal artifacts. Note also how the bipolar head (outer shell) in b has a slightly greater than hemispheric shape and lacks screw holes, additional clues that this is not an acetabular cup. ... CT Scan. Coronal reformatted CT images of two different total hip prostheses show metal-on-metal (a) (cf Fig 3a) and ceramic-on-polyethylene (b) bearing surfaces. High-quality CT scans require the use of a multidetector scanner with modification of technical imaging parameters to minimize artifacts. Axial CT showed an intact prosthesis. CT scans have various purposes. Calcar resorption and stress shielding result from decreased stress to bone; their presence around a fixed component is normal (Fig 10) (28,30), and they should be distinguished from osteolysis. A CT scan can help diagnose problems in the pelvic and hip area. It should be noted, however, that radiolucent areas less than 2 mm could indicate loosening if they are new or changing, and areas greater than 2 mm that have been stable may be acceptable. This study describes the normal and pathologic patterns of a bone scan and exemplifies ten common situations that can cause pain in patients with hip … Other complications include neurovascular injury, leg length discrepancy, periprosthetic fracture, dislocation or subluxation, osteolysis, loosening, heterotopic ossification, pseudobursa formation, metal sensitivity or toxicity, and wear or breakage of hardware. But in some instances an MRI scan may not be recommended. CT scans use X-ray technology and advanced computer analysis to create detailed pictures of your body. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. This finding was clinically suspected, but the fracture line was radiographically occult.Figure 20Download as PowerPointOpen in Image In uncemented femoral stems, it is normal to have mild subsidence (<10 mm) in the first year after arthroplasty (28,29). Viewer. Sagittal reformatted CT image shows focal sclerosis (arrow) at the tip of an uncemented femoral stem, a finding known as pedestal formation.Figure 13Download as PowerPointOpen in Image -Tricalcium Phosphate Scaffold in Human Bone Defects: A Prospective, Controlled Feasibility Trial, Metal Artifact Reduction in Pelvic Computed Tomography With Hip Prostheses, Hybrid SPECT/CT for the assessment of a painful hip after uncemented total hip arthroplasty, Metallosis: A diagnosis not only in patients with metal-on-metal prostheses, Cross-sectional imaging of metal-on-metal hip arthroplasties, Reduction of Metal Artifacts From Alloy Hip Prostheses in Computer Tomography, Current literature and imaging techniques of aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL), Total ankle arthroplasty: optimizing computed tomography imaging protocol, Magnetresonanztomographische Untersuchungen bei Problemen mit Metall-auf-Metall-Implantaten, Reduction of Metal Artifacts from Hip Prostheses on CT Images of the Pelvis: Value of Iterative Reconstructions, Limb-Sparing Surgery for Distal Femoral and Proximal Tibial Bone Lesions: Imaging Findings With Intraoperative Correlation, Comparison of metal artifact in digital tomosynthesis and computed tomography for evaluation of phantoms, Appreciating MoM: Demystifying the Complications of Metal-on-metal Hip Articulations, What the Radiologist Needs to Know about Hip Resurfacing Arthroplasty: Indications, Normal Radiologic Findings and Detection of Complications, Hips Don't Lie: Detection of Risk Factors and Complications of Total Hip Arthroplasty in Plain Radiograph and CTÂ, Virtual Monochromatic Spectral Imaging with Fast Kilovoltage Switching: Reduction of Metal Artifacts at CT, The Expanding Role of MRI in the Evaluation of Periprosthetic Hip Joint Infection. There are no restrictions placed on you after this procedure. Note how the metal cup in each case directly abuts trabecular bone (white arrow). CT allows better detection, characterization, and quantification of osteolysis around the cup, as well as more accurate estimation of the total amount of the cup that is fixed to bone (Fig 17) (6–10,37). 23, No. A basic understanding of hip reconstruction and hip implants is required for proper image interpretation. 4, 30 November 2016 | European Journal of Orthopaedic Surgery & Traumatology, Vol. Figure 15 Cement mantle fracture. Hip pain is fairly common. In uncemented implants, visible areas of bone in-growth indicate solid fixation (28). I would like to say that if there is any indication of hip replacement surgery then you need to see orthopedic surgeon for evaluation and few important tests which also includes CT scan Hip joint. Bearing surfaces. A unipolar hemiprosthesis has one articulation between the metal implant head and the native acetabular cartilage surfaces. Coronal reformatted CT image of a total hip prosthesis shows a loose acetabular cup, including cup tilt and migration; screw fracture (arrow); and bead shedding (circles).Figure 14Download as PowerPointOpen in Image A total hip replacement surgery with the Mako system will help reduce pain in patients whose hips are not working properly due to arthritis. At the very least, pedestal formation should be closely followed up (28,29).Figure 13 Periprosthetic sclerosis. Once this is established, proper imaging can be performed to better understand how to provide relief. Modern hip arthroplasty is a relatively safe procedure (26), but there are many potential complications of hip joint replacement. Liner wear occurs with all joint replacements, but it occurs fastest between metal or ceramic heads and polyethylene liners. CT can augment radiography for precise definition of the position of components, such as acetabular cup orientation and version (31–33). Note the horizontal streak (arrows) representing artifact related to significant attenuation of the x-ray beam from the combined femoral stems. Small voids representing air bubbles in the mantle of cemented components are also acceptable (Fig 11) (36).Figure 11 Normal low-attenuation areas. (b) Coronal reformatted image obtained a few years later reveals loosening of the (tilted) femoral stem, which proved to be secondary to infection. (b) Axial noncontrast CT scan obtained in a different patient with a metal-on-metal implant shows periprosthetic collections lined by dense debris (arrows), findings that proved at surgery to represent metallosis. However, those which have titanium implants can go for MRI, there is no harm. However, they can be of great importance if they are present in large or increasing amounts (Fig 12) and should be closely monitored (29). Note the cup liner wear (black arrow). Components can dissociate, as when a polyethylene liner is displaced from the space between the metal femoral head and the acetabular metal backing (3). This finding may manifest as (a) an acetabular cup that has tilted or migrated; or (b) a femoral stem that has rotated, migrated, toggled (“windshield wiper” effect), or excessively subsided (Figs 14, 17, 18). For … Proper implant position is necessary for optimal function and patient satisfaction. ... TomoTherapy is based on delivering radiotherapy using the same sort of machine as a CT scanner. (a) Coronal reformatted CT image shows stem subsidence of over 10 mm, with sclerosis and endosteal remodeling next to the stem tip (arrow). 8, American Journal of Roentgenology, Vol. 1, 23 February 2017 | International Journal of Computer Assisted Radiology and Surgery, Vol. © 2021 Cedars-Sinai. However, if the bipolar head of a hemiprosthesis has worn down the acetabular cartilage and protrudes into the subchondral bone plate, it could be misinterpreted as an acetabular cup in a reamed acetabulum from total hip arthroplasty. 100, No. CT can also depict the position of hardware relative to adjacent soft tissues, such as cup overhang and its relationship to the iliopsoas muscle (overhang >12 mm is associated with iliopsoas impingement) (34) or the position of a screw tip (Fig 6). 1, 30 November 2016 | MUSCULOSKELETAL SURGERY, Vol. A CT scan can help diagnose problems in the pelvic and hip … Your doctor has requested a computed tomography scan (CT or CAT) of your pelvis/hip bones. In our experience, questions of particular importance to the orthopedic surgeon include (a) whether there are cavitary or segmental defects (ie, holes surrounded by bone or extending through the bone), especially posteriorly and superiorly; and (b) whether there is pelvic discontinuity (ie, the superior and inferior portions of the socket are discontinuous). Metal-on-polyethylene bearing surfaces are most commonly encountered, but alternative bearing surfaces include metal-on-metal, ceramic-on-polyethylene, and ceramic-on-ceramic surfaces. CT can be used to supplement the radiographic assessment of symptomatic prosthetic hips when evaluation is performed for a number of these complications. A higher pitch (>1) is good for fast scanning because there is rapid table motion relative to the revolving gantry; however, some CT projection data are skipped and reconstruction artifacts may be exaggerated. The two main subtypes of hemiprostheses are unipolar and bipolar in design (Fig 2). II. Comparison of Metal Artifact Reduction for Orthopedic Implants versus Standard Filtered Back Projection: Value of Postoperative CT after Hip Replacement, An exploratory study into measuring the cortical bone thickness from CT in the presence of metal implants, Periprosthetic Femoral Fractures in the Emergency Department: What the Orthopedic Surgeon Wants to Know, Imaging in peri-prosthetic assessment: an orthopaedic perspective, Bone scan usefulness in patients with painful hip or knee prosthesis: 10 situations that can cause pain, other than loosening and infection, Pelvic Beam-Hardening Artifacts in Dual-Energy CT Image Reconstructions: Occurrence and Impact on Image Quality, Imaging After Hip Joint Replacement Surgery in the Elderly Population, Metal artifact reduction (MAR) based on two-compartment physical modeling: evaluation in patients with hip implants, Metallosis in shoulder arthroplasty: an integrative review of literature, Le scanner des prothèses de hanche : techniques et indications, Évolution de l’imagerie des prothèses de hanche : algorithme diagnostique, CT of hip prosthesis: New techniques and new paradigms, Developments in imaging methods used in hip arthroplasty: A diagnostic algorithm, [124I]FIAU: Human dosimetry and infection imaging in patients with suspected prosthetic joint infection, Utilizing Autologous Multipotent Mesenchymal Stromal Cells and The performance and interpretation of the uncemented femoral stem ( solid arrow ) osteolysis in a and.. 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Surgery & Traumatology, Vol stem with a symptomatic right total hip prosthesis to prosthesis. Commonly revised because of their relative opacity and attenuation differences ( Fig 1 ) joint replacements, but there many. The component solidly to bone and a conventional type implant ( a ) and a bipolar (.