The painful hip prosthesis: value of nuclear imaging in the diagnosis of late complications.

Loosening of the prosthesis and infection are the most common late complications of the Charnley low friction arthroplasty. A noninvasive diagnostic approach to the symptomatic patient, using plain radiographs and nuclear imaging with a bone imaging agent, is presented. Nuclear imaging is a more sensitive indicator than plain radiography, but the two studies supplement each other. The nuclear study may be positive when radiographs are normal and in no patient with loosening was the nuclear image normal. In the presence of a normal nuclear image and a normal radiograph, there is an extremely small probability that either complication is present.