6. X RAY
• 4 VIEWS
• PELVIS AP
• AP OF THE AFFECTED HIP
• LATERAL VIEW
• SHOOT THROUGH LATERAL
7.
8. CT, SPECT and MRI
• CT scans have also been useful in planning for revision surgery and is an
excellent tool for evaluating component positioning
• MRI is useful in the evaluation of failed metal on metal total hip
arthroplasty, where with special metal artifact subtraction sequences it can
be used to demonstrate adverse local tissue reactions
• Other uses of MRI are to evaluate the soft tissue status in osteolysis with
cortical breaches
• SPECT in addition to CT will give better understanding of loosening and
heterotrophic ossification
9. Bone scans
• Suspicion Of Infection Is An Indication For Bone
Scans
• The Combination Of Technetium- Or Indium
Labeled White Cells And Technetium-labeled
Sulfur Colloid Has Excellent Results, With
Accuracy Of Over 90% In Assessing The Focus
• Fluorodeoxyglucose–positron Emission
Tomography (FDG-PET) Scanning Has Variable
Performance
• Aseptic Loosening Related To Particle Disease
Can Cause Increased FDG Uptake
FDG-
PET
13. CLASSIFICATION: Paprosky Classification of Femoral Bone Deficiencies
• Type I: Minimal loss of metaphyseal cancellous bone with intact diaphysis
• Type II: Extensive loss of metaphyseal cancellous bone with intact diaphysis
• Type IIIA: Severely damaged, nonsupportive metaphysis, with >4 cm of intact diaphyseal bone
available for distal fixation
• Type IIIB: Severely damaged, nonsupportive metaphysis, with <4 cm of intact diaphyseal bone
available for distal fixation
• Type IV: Extensive damage to metaphysis and diaphysis, with widened femoral canal,
nonsupportive isthmus
17. Type III B
Severely damaged,
nonsupportive metaphysis, with
<4 cm of intact diaphyseal bone
available for distal fixation
18. Type IV
Extensive damage to
metaphysis and diaphysis,
with widened femoral canal,
non-supportive isthmus
19. Other classifications –
American Academy of Orthopaedic Surgeons Femoral Bone Loss
Classification Type Description
• I Segmental defect
• II Cavitary defect
• III Combined segmental and
• cavitary defect
• IV Femoral malalignment
• (rotational or angular)
• V Femoral stenosis
• VI Femoral discontinuity
20. HOW? METAPHYSIS SUPPORT
ISTHMUS SUPPORT
PRIMARY STEM
TAPERED STEM
13 CM BONE FROM
INTERCONDYLAR NOTCH
CEMENTED
PROSTHESIS LONG
STEM/ DISTAL LOADING
STEM UNCEMENTED
AT LEAST 2.5 MM
THICKNESS OF CORTICAL
BONE OVER A DISTANCE OF
AT LEAST 6 CM? IN DISTAL
DIAPHYSIS
MEGAPROSTHESIS/
OSSEOINTEGRATION
DEVICES
TOTAL FEMUR
NO
YES
YES
NO
NO
NO
21.
22.
23. LITERATURE
• John Callaghan, THE ADULT HIP, HIP ARTHROPLASTY SURGERY, 3rd edition, wolters kluwer
• Neil P. Sheth, MD, et al, Femoral Bone Loss in Revision Total Hip Arthroplasty: Evaluation and Management; J
Am Acad Orthop Surg 2013;21: 601-612
• Cavalli L and Brandi ML. Periprosthetic bone loss: diagnostic and therapeutic approaches F1000Research 2014,
2:266
• Lombard, C et al; Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging strategy. J.
Clin. Med. 2022, 11, 4416. https://doi.org/ 10.3390/jcm11154416
• Dobrindt et al. Hybrid SPECT/CT for the assessment of a painful hip after uncemented total hip arthroplasty;
BMC Medical Imaging (2015) 15:18
• James V Bono; REVISION HIP ARTHROPLASTY, 1999 Springer-Verlag
24. • Stable fixation is to be achieved on table with available bone
• Care should be taken to avoid intraoperative fractures
• Extensive pre operative planning
