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Computed Tomography in the Assessment of Periacetabular Osteolysis
Serena Leung, MS1; Douglas Naudie, MD, FRCSC2; Nobuto Kitamura, MD1; Tim Walde, MD3; Charles A. Engh, MD1
1 Anderson Orthopaedic Research Institute, P.O. Box 7088, Alexandria, VA 22307. E-mail address for S. Leung: sleung@aori.org
2 Division of Orthopaedic Surgery, University of Western Ontario, London Health Sciences Center, University Campus, London, ON N6A 5A5, Canada
3 Department of Traumatology, Plastic and Reconstructive Surgery, University of Goettingen, Robert-Koch Strasse 40, 37075 Goettingen, Germany
View Disclosures and Other Information
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Inova Health Care Services. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. 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.
Investigation performed at the Anderson Orthopaedic Research Institute, Alexandria, Virginia

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Mar 01;87(3):592-597. doi: 10.2106/JBJS.D.02116
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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 space.

Conclusions: In this autopsy model, computed tomography was an accurate method for detecting the location and measuring the volume of periacetabular osteolytic lesions.

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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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