Department of Radiology, Hospital Clinic, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain.
Department of Infectious Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Skeletal Radiol. 2020 Jun;49(6):893-902. doi: 10.1007/s00256-019-03355-1. Epub 2020 Jan 3.
The differentiation between delayed aseptic and septic complications of total hip arthroplasty is crucial to allow appropriate surgical planning and timely antimicrobial treatment. The aim of this study was to investigate the utility of multidetector computed tomography (CT) findings to diagnose aseptic mechanical loosening, granulomatous reaction, and periprosthetic joint infection in patients who underwent total hip arthroplasty before revision surgery.
Ninety-six consecutive patients with a clinical suspicion of periprosthetic complications underwent revision surgery over an 8-year period. All patients had been evaluated preoperatively using multidetector CT without contrast media. Two blinded musculoskeletal radiologists reviewed multidetector CT images, including periprosthetic soft-tissue accumulation, prosthetic acetabular malposition, periprosthetic osteolysis, enlarged iliac lymph nodes, and heterotopic ossification. Risk factors for aseptic and septic loosening were identified using multivariate analysis.
Multidetector CT-related variables independently associated with periprosthetic joint infection were high periprosthetic soft-tissue accumulation, periprosthetic osteolysis without expansile periosteal reaction and enlarged iliac lymph nodes. On the other hand, the absence of the following radiological signs: low or high periprosthetic soft-tissue accumulation, mild or severe periprosthetic osteolysis, and enlarged iliac lymph nodes, were predictors of aseptic mechanical loosening. Low periprosthetic soft-tissue accumulation, severe periprosthetic osteolysis with expansile periosteal reaction, and mild acetabular malposition were significant variables associated with granulomatosis.
Multidetector CT findings are useful to differentiate between aseptic and septic complications before revision surgery. The presence of osteolysis with expansile periosteal reaction appeared to be a time-dependent variable.
区分全髋关节置换术后的无菌性和感染性并发症对于进行适当的手术规划和及时的抗菌治疗至关重要。本研究旨在探讨多排螺旋 CT（multidetector CT，MDCT）在诊断全髋关节置换术前翻修患者的无菌性机械性松动、肉芽肿反应和假体周围关节感染中的作用。
在 8 年的时间里，96 例临床怀疑假体周围并发症的连续患者接受了翻修手术。所有患者均在术前接受了 MDCT 检查，未使用造影剂。两位盲法的肌肉骨骼放射科医生对 MDCT 图像进行了评估，包括假体周围软组织堆积、髋臼假体位置不当、假体周围骨溶解、髂内淋巴结肿大和异位骨化。使用多变量分析确定无菌性和感染性松动的危险因素。
与假体周围关节感染相关的 MDCT 变量包括高假体周围软组织堆积、假体周围骨溶解而无膨胀性骨膜反应和髂内淋巴结肿大。另一方面，以下影像学征象的不存在：低或高假体周围软组织堆积、轻度或重度假体周围骨溶解、髂内淋巴结肿大，是无菌性机械性松动的预测因素。低假体周围软组织堆积、严重的假体周围骨溶解伴膨胀性骨膜反应和轻度髋臼位置不当是与肉芽肿病相关的重要变量。
MDCT 检查结果可用于在翻修术前区分无菌性和感染性并发症。伴有膨胀性骨膜反应的骨溶解似乎是一个时间相关的变量。
