Scientific Article   |    
Comparison of Preoperative Radiographs and Intraoperative Findings of Fixation of Hemispheric Porous-Coated Sockets
Pacharapol Udomkiat, MD; Zhinian Wan, MD; Lawrence D. Dorr, MD
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Investigation performed at The Arthritis Institute at Centinela Hospital Medical Center, Inglewood, California

Pacharapol Udomkiat, MD
Zhinian Wan, MD
Lawrence D. Dorr, MD
The Arthritis Institute at Centinela Hospital Medical Center, 501 East Hardy Street, 3rd Floor, Inglewood, CA 90301

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Orthopedic Research Institute at Good Samaritan Hospital, Los Angeles, California. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Sulzer Medica). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2001 Dec 01;83(12):1865-1870
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Background: The radiographic criteria for identification of loose cementless acetabular components have not been well established. The purpose of this study was to compare the radiographic appearance of a hemispheric porous-coated cementless cup fixed with screws with the intraoperative findings with regard to the fixation status.

Methods: The quality of the cup fixation was evaluated at fifty-two hip revisions that were performed, for reasons other than infection, at an average of 89.9 months (range, 33.8 to 150.1 months) after the primary operations. The fixation status at the revision surgery was compared with the findings on sequential anteroposterior and lateral radiographs of these sockets. Sequential radiographs of an additional 100 total hip replacements that had not required a reoperation and that had been followed for an average of 121 months were also measured.

Results: Loosening of the socket was radiographically identified by (1) radiolucent lines that initially appeared after two years, (2) progression of radiolucent lines after two years, (3) radiolucent lines in all three zones, (4) radiolucent lines 2 mm or wider in any zone, or (5) migration. The sensitivity of these criteria was 94%, and the specificity was 100%. The criteria had a positive predictive value of 100% and a negative predictive value of 97%.

Conclusions: The most predictive radiographic findings for early diagnosis of loosening of a hemispheric porous-coated cup were progression of radiolucent lines more than two years after the operation and any new radiolucent line of 1 mm or wider that appeared more than two years postoperatively. Sequential anteroposterior and lateral radiographs are necessary to assess the time of onset and progression of radiolucent lines in order to identify loose hemispheric porous-coated cups accurately.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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