Background: Computed tomography recently has been proposed as an
accurate method for diagnosing periacetabular osteolytic lesions. Several
investigators have attempted to validate the accuracy of this technique, but
they employed cadaveric and animal models, which cannot replicate the adaptive
changes that occur over time in vivo. This study was performed to determine
the accuracy of computed tomography in identifying and measuring
periacetabular osteolytic lesions in hemipelves retrieved at autopsies of
individuals with a previously well-functioning total hip prosthesis.
Methods: We evaluated nine hemipelves, retrieved at autopsy, that
contained a cementless porous-coated acetabular component. The fresh specimens
were examined with conventional radiographs and computed tomography and then
were embedded and sectioned into 1.5-mm slices for evaluation with slab
radiographs. Anteroposterior and iliac oblique plain radiographs as well as
axial, coronal, and sagittal computed tomography scans were reviewed to
determine the presence and location of any periacetabular osteolytic lesions.
These results were then compared with those identified on the slab
radiographs. Lesion volume was calculated from computed tomography scans with
use of post-processing software.
Results: A total of twenty-three periacetabular osteolytic lesions
were identified on the slab radiographs of the nine hemipelves. The plain
radiographs identified twelve (52%) of the twenty-three lesions, and the
computed tomography scans identified twenty (87%) of the twenty-three lesions.
Three medial wall perforations were identified on the computed tomography
scans but were not detected on the plain radiographs. Computed tomography was
accurate in measuring the volume of the osteolytic lesions (r2 =
0.997) but tended to overestimate the volumes measured on the slab
radiographs. Periacetabular osteolytic lesions appeared on the computed
tomography scans and slab radiographs as areas devoid of trabecular bone that
were delineated by a sclerotic border and communicated with the joint
Conclusions: In this autopsy model, computed tomography was an
accurate method for detecting the location and measuring the volume of
periacetabular osteolytic lesions.