He Aoyang, Zhang Yao, Lu Chunmiao, Cao Lei, Liu Jicun, Zhong Zhiwei
Department of Radiology, Hebei Medical University Third Hospital, Shijiazhuang, 050051, China.
BMC Musculoskelet Disord. 2025 Apr 21;26(1):396. doi: 10.1186/s12891-025-08607-x.
The purpose of this study was to provide more accurate imaging diagnostic parameters for acetabular cup loosening through radiological characteristic of acetabular cup aseptic loosening after cementless total hip arthroplasty, especially for patients lacking postoperative baseline or serial follow-up radiographs.
The radiographic data of patients who underwent primary unilateral cementless total hip arthroplasty in our hospital from January 2017 to July 2024 were retrospectively studied. Forty-one patients with aseptic loosening of the acetabular cup, confirmed by surgery or consensus between clinicians and radiologists, were included in the loosening group. Sixty-one patients who underwent primary total hip arthroplasty and were evaluated more than one year postoperatively were included as the control group. The absence of postoperative complications was confirmed through discussions between clinicians and radiologists. Radiographic examination of the contralateral hip joint in all included patients showed no significant abnormalities. The following imaging parameters were measured on anteroposterior bilateral hip radiography: acetabular cup inclination (AA), acetabular difference in vertical distance 1 (DVD1), acetabular difference in vertical distance 2 (DVD2), acetabular difference in horizontal distance (DHD), wide radiolucent zones around the acetabular cup (TA), number of wide radiolucent zones around the acetabular cup (NTA) and difference in head-cup edge distance (DHCD).
The numerical value of TA, DVD1, DHCD, AA and NTA in the loosening group was significantly higher than in the control group, and the differences were all statistically significant (P < 0.05). The critical values of DVD1, DHCD, AA and NTA were 1.49 cm, 0.16 cm, 53.2 ° and 1, respectively. The combined imaging diagnostic criteria for acetabular cup loosening are defined as the simultaneous fulfillment of the following two conditions: (1) NTA ≥ 1; (2) AA ≥ 53.2° or DHCD ≥ 0.16 cm. The results of the validation analysis were statistically significant.
The combined imaging diagnostic criteria for aseptic loosening of the acetabular cup after total hip arthroplasty, established in this study, demonstrate superior diagnostic efficacy compared to single imaging parameters. This approach does not rely on postoperative baseline radiographs or serial follow-up radiographs and can accurately determine the specific location of prosthetic loosening.
本研究旨在通过非骨水泥型全髋关节置换术后髋臼杯无菌性松动的影像学特征，为髋臼杯松动提供更准确的影像学诊断参数，尤其适用于缺乏术后基线或系列随访X线片的患者。
回顾性研究2017年1月至2024年7月在我院接受初次单侧非骨水泥型全髋关节置换术患者的影像学资料。髋臼杯无菌性松动经手术证实或临床医生与放射科医生共同确认的41例患者纳入松动组。61例接受初次全髋关节置换术且术后随访超过1年的患者作为对照组。通过临床医生与放射科医生讨论确认无术后并发症。所有纳入患者对侧髋关节的X线检查未发现明显异常。在双侧髋关节前后位X线片上测量以下影像学参数：髋臼杯倾斜度（AA）、髋臼垂直距离差1（DVD1）、髋臼垂直距离差2（DVD2）、髋臼水平距离差（DHD）、髋臼杯周围宽透亮区（TA）、髋臼杯周围宽透亮区数量（NTA）以及股骨头-髋臼杯边缘距离差（DHCD）。
松动组TA、DVD1、DHCD、AA和NTA的数值显著高于对照组，差异均有统计学意义（P＜0.05）。DVD1、DHCD、AA和NTA的临界值分别为1.49 cm、0.16 cm、53.2°和1。髋臼杯松动的联合影像学诊断标准定义为同时满足以下两个条件：（1）NTA≥1；（2）AA≥53.2°或DHCD≥0.16 cm。验证分析结果具有统计学意义。
本研究建立的全髋关节置换术后髋臼杯无菌性松动的联合影像学诊断标准，与单一影像学参数相比，具有更高的诊断效能。该方法不依赖术后基线X线片或系列随访X线片，能够准确确定假体松动的具体位置。
