Hochman Mary G, Melenevsky Yulia V, Metter Darlene F, Roberts Catherine C, Bencardino Jenny T, Cassidy R Carter, Fox Michael G, Kransdorf Mark J, Mintz Douglas N, Shah Nehal A, Small Kirstin M, Smith Stacy E, Tynus Kathy M, Weissman Barbara N
Principal Author, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Research Author, Medical College of Georgia at Augusta University, Augusta, Georgia.
J Am Coll Radiol. 2017 Nov;14(11S):S421-S448. doi: 10.1016/j.jacr.2017.08.036.
Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in the United States and annual demand for primary TKA is expected to grow by 673% by 2030. The first part provides an overview of imaging modalities (radiographs, CT, MRI, ultrasound, and various nuclear medicine studies) and discusses their usefulness in the imaging evaluation of TKA. The second part focuses on evidence-based imaging and imaging-guided intervention algorithms for the workup of TKA and its complications, including routine follow-up, component wear, periprosthetic infection, aseptic loosening, granulomas/osteolysis, conventional and rotational instability, periprosthetic fracture, patellar complications, and a variety of periprosthetic soft tissue abnormalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
全膝关节置换术（TKA）是美国最常实施的关节置换手术，预计到2030年，原发性TKA的年需求量将增长673%。第一部分概述了成像方式（X线片、CT、MRI、超声和各种核医学检查），并讨论了它们在TKA成像评估中的作用。第二部分重点介绍了基于证据的成像以及用于TKA及其并发症检查的成像引导干预算法，包括常规随访、假体部件磨损、假体周围感染、无菌性松动、肉芽肿/骨质溶解、传统和旋转不稳定、假体周围骨折、髌骨并发症以及各种假体周围软组织异常。美国放射学会适宜性标准是针对特定临床情况的循证指南，每年由多学科专家小组进行审查。指南的制定和修订包括对同行评审期刊上的当前医学文献进行广泛分析，以及应用成熟的方法（兰德/加州大学洛杉矶分校适宜性方法和推荐分级评估、制定与评价或GRADE）来评估特定临床场景下成像和治疗程序的适宜性。在缺乏证据或证据不明确的情况下，专家意见可能会补充现有证据以推荐成像或治疗方法。
