Multimedia
 | Media file 1: Image from a patient who had a normal, hybrid-type total hip arthroplasty. This anteroposterior radiograph shows the femoral (metal, cemented) and acetabular (polyethylene cup with metal backing, cementless) components. (See Images 1-7.) |
 | Media file 2: Image from a patient who had a normal total hip arthroplasty. This frog-leg radiograph shows the femoral (metal, press fit, cementless) and acetabular (polyethylene cup with metal backing, screw fixation) components. (See Images 1-7.) |
 | Media file 3: Image from a patient who had a normal total hip arthroplasty. This frog-leg radiograph shows the femoral (metal, cemented) and the acetabular (polyethylene, cemented [yellow arrow]) components. (See Images 1-7.) |
 | Media file 4: Image from a patient who had a normal total hip arthroplasty. This anteroposterior radiograph shows the femoral (ceramic head [yellow arrow], metal stem, cementless, porous) and acetabular (polyethylene cup, metal backing, cementless, porous) components. Note the extensive reaming that is deep to the acetabular cup, creating a lucency of the rim fit of the acetabular component. (See Images 1-7.) |
 | Media file 5: Image from a patient who had a normal total hip arthroplasty. This frog-leg radiograph shows the femoral (metal head and stem, cemented) and acetabular (metal, cementless) components. Note the large metal femoral head articulating with the metal acetabular cup (arrows). (See Images 1-7.) |
 | Media file 6: Image from a patient who had a normal total hip arthroplasty. This frog-leg radiograph shows the femoral (ceramic head [arrow], metal stem, cementless, cable) and acetabular (ceramic cup, metal backing, cementless) components. Note the density of the ceramic head, which is less dense than metal. (See Images 1-7.) |
 | Media file 7: Image from a patient who had a normal total hip arthroplasty. This coronal computed tomography reformatted image shows the femoral (ceramic head [right yellow arrow], metal stem, cementless, cable) and acetabular (ceramic cup [top yellow arrow], metal backing, cementless) components. (See Images 1-7.) |
 | Media file 8: Image from a patient who had a normal resurfacing total hip arthroplasty. This anteroposterior radiograph shows the femoral (metal head and stem) and acetabulum components (metal, cementless). Note the large femoral head and the preserved femoral neck. |
 | Media file 9: Image from a patient who had a normal unipolar hemiarthroplasty (same patient in Images 9 and 10). This anteroposterior radiograph shows the femoral component (metal, cementless) and the normal, native acetabulum. |
 | Media file 10: Image from a patient who had a normal unipolar hemiarthroplasty (same patient in Images 9 and 10). This frog-leg radiograph shows the femoral component of the unipolar hemiarthroplasty (metal, cementless). Note the normal sclerotic bone of the acetabulum (which indicates no surgical reaming) and the normal lucent hyaline cartilage between the acetabulum and the femoral head (arrow). |
 | Media file 11: Image from a patient who had a normal bipolar hemiarthroplasty. This anteroposterior radiograph shows the femoral (metal head and stem, cemented) and acetabular components (polyethylene cup, metal backing). Note the normal appearance of the acetabulum without reaming (arrow) and the lucency between the acetabulum and cup, which represents the normal acetabular articular cartilage. |
 | Media file 12: Image from a patient who had a normal bipolar hemiarthroplasty. This anteroposterior radiograph shows the femoral (metal head and stem, cemented) and acetabular components (polyethylene cup, metal backing). Note the angle between the edge of the acetabular cup and the horizontal in comparison to Image 13. |
 | Media file 13: Image from a patient who had a normal bipolar hemiarthroplasty. This frog-leg radiograph shows the femoral (metal head and stem, cemented) and acetabular components (polyethylene cup, metal backing). Note the angle between the edge of the acetabular cup and the horizontal in comparison to Figure 12. The motion between the acetabular cup and the native acetabulum is normal. |
 | Media file 14: Image from a patient who had a normal total hip arthroplasty. This anteroposterior radiograph shows the cement restrictor or centralizer (arrow) distal to the cemented femoral stem. |
 | Media file 15: Image from a patient who had a normal total hip arthroplasty. This anteroposterior radiograph shows "spot welds" (arrows) that indicate bone ingrowth at the cementless femoral stem. |
 | Media file 16: Image from a patient who had a normal total hip arthroplasty. This frog-leg radiograph shows cables (arrow) at the site of a trochanteric osteotomy. |
 | Media file 17: Illustration of the lateral inclination of an acetabular component (adapted from Manaster BJ. Radiographics. 1996;16(3):648.). 6 The angle between the rim of the acetabular cup and the ischial tuberosities should normally be from 30-50º. |
 | Media file 18: Illustration of an anteversion of an acetabular component (adapted from Manaster BJ. Radiographics. 1996;16(3):649.). 6 Normal anteversion of the acetabular cup is 5-25º on a lateral hip radiograph. |
 | Media file 19: Image from a patient who had a normal total hip arthroplasty. This true lateral radiograph shows the normal degree of acetabular component anteversion (dashed line). Courtesy of Dr JC Hodge, New York. |
 | Media file 20: Illustration of the vertical assessment of a femoral component (adapted from Manaster BJ. Radiographics. 1996;16(3):648.). 6 The distance from the center of each femoral head to the lines that intersect the ischial tuberosities (between lines A and C) and to the greater trochanters (between lines B and C) should be symmetric. |
 | Media file 21: Illustration of the horizontal assessment of a femoral component (adapted from Manaster BJ. Radiographics. 1996;16(3):648.). 6 A line drawn from the center of each femoral head to the adjacent acetabular tear drop (which represents the acetabular margin of the medial hip joint space) should be symmetric. |
 | Media file 22: Image from a patient who had a cemented total hip arthroplasty. This anteroposterior radiograph shows a <2 mm-thick normal periprosthetic lucency (arrow) at the bone-cement interface, which is demarcated by a thin, sclerotic line (ie, demarcation line). |
 | Media file 23: Image from a patient who had a cemented total hip arthroplasty. The lucency about the femoral stem is demarcated by a sclerotic line (arrows) that measures <2 mm thick. The lucency was stable over time. |
 | Media file 24: Image from an asymptomatic patient who had bone resorption under the femoral flange (arrow) that measured 4 mm thick. |
 | Media file 25: Image from a patient who had a cemented total hip arthroplasty and stress shielding. This anteroposterior radiograph shows localized osteopenia (arrow) of the greater trochanter as a result of diverted mechanical stress from the secure arthroplasty. |
 | Media file 26: Image of a patient who had a cemented total hip arthroplasty and stress shielding. This frog-leg radiograph shows focal osteopenia involving both the lesser and greater trochanteric regions (arrows) as a result of diverted stress. |
 | Media file 27: Image of pedestal formation from a patient who had a cementless total hip arthroplasty. This radiograph of the distal femoral stem shows an adjacent sclerosis. |
 | Media file 28: Image from a patient who had a cementless total hip arthroplasty. This anteroposterior radiograph shows an acute posterosuperior dislocation of the femoral head from the acetabulum. |
 | Media file 29: Image from a patient who had a cementless bipolar hemiarthroplasty. This anteroposterior radiograph shows a varus angulation between the femoral stem and the femoral shaft (black line) that predisposed the bone to stress and fracture at the lateral femoral cortex (arrow). |
 | Media file 30: Image from a patient who had a cemented total hip arthroplasty. This frog-leg radiograph shows medial extrusion (arrow) of polymethylmethacrylate (PMMA) cement. |
 | Media file 31: Image from a patient who had a prosthesis failure from a cemented unipolar hemiarthroplasty. This anteroposterior radiograph shows a femoral stem fracture (arrow). |
 | Media file 32: Image from a patient who had a prosthesis failure from a total hip arthroplasty. This anteroposterior radiograph shows a fractured and displaced ceramic femoral head (arrow). The femoral neck is in direct contact with the superolateral aspect of the polyethylene acetabular liner. Note the fracture of an acetabular screw and the ceramic fragments within the joint. |
 | Media file 33: Image from a patient who had a prosthesis failure from a total hip arthroplasty. This frog-leg radiograph shows the fragmented and displaced acetabular component. The lucent polyethylene liner has rotated and appears as an oval lucency that projects over the femoral neck (open arrow), whereas the associated metal ring (arrow) is disrupted and displaced. The femoral head is protruding into the native acetabulum. |
 | Media file 34: Image from a patient who had a prosthesis failure from a total hip arthroplasty. This frog-leg radiograph shows a displaced greater trochanteric fracture (arrow). |
 | Media file 35: Image from a patient who had a resurfacing hemiarthroplasty. This frog-leg radiograph shows a displaced osseous femoral neck fracture (arrows) adjacent to the hip arthroplasty. |
 | Media file 36: Image from a patient who had a total hip arthroplasty. This anteroposterior radiograph shows an acetabular fracture (arrow). Note the abnormal anteversion and lateral rotation of the acetabular component. |
 | Media file 37: Image from a patient who had a total hip arthroplasty. This axial computed tomography scan shows an acetabular fracture (arrow). |
 | Media file 38: Image from a patient who had a total hip arthroplasty. This anteroposterior radiograph shows an ill-defined and nonbridging early heterotopic ossification. |
 | Media file 39: Image from a patient who had a total hip arthroplasty. This anteroposterior radiograph shows a well-defined, late heterotopic ossification (arrow) with continuous cortical bone and visualized trabeculae. |
 | Media file 40: Image from a patient who had a cemented total hip arthroplasty with femoral subsidence. This anteroposterior radiograph shows an abnormal lucency (arrow) distal to the femoral stem. |
 | Media file 41: Follow-up image from a patient who had a cemented total hip arthroplasty with femoral subsidence (same patient as in Image 40). This anteroposterior radiograph shows an interval subsidence of the femoral component (arrow). |
 | Media file 42: Image from a patient who had a cemented total hip arthroplasty with abnormal prosthesis motion. This anteroposterior radiograph shows the cemented acetabular cup has rotated medially, resulting in an abnormal surrounding lucency, which indicates loosening. The femoral head is in contact with the ilium. |
 | Media file 43: Image from a patient who had a cemented total hip arthroplasty with abnormal prosthesis motion. This anteroposterior radiograph shows abnormal lucencies at the metal-cement and cement-bone interfaces of the acetabular component and the presence of acetabular protrusion. |
 | Media file 44: Follow-up image from a patient who had a cemented total hip arthroplasty with abnormal prosthesis motion (same patient as in Image 43). This anteroposterior radiograph shows an interval vertical rotation of the acetabular cup and shows fracture of the acetabular screws indicating component loosening. |
 | Media file 45: Image from a patient who had a cemented total hip arthroplasty. This frog-leg radiograph shows a fracture of the cement (arrow) distal to the femoral stem. Note the angulation of the femoral diaphysis, which is related to abnormal stress and has an increased risk of fracture. |
 | Media file 46: Image from a patient who had a cementless total hip arthroplasty. This anteroposterior radiograph shows bead shedding (top, small arrow) from the porous ingrowth surface of the femoral component (bottom, large arrow). |
 | Media file 47: Image from a patient who had a cemented total hip arthroplasty with a subsequent loose femoral component. This anteroposterior radiograph shows a >2 mm lucency at the metal-cement interface (arrows). |
 | Media file 48: Image from a patient who had a bipolar hemiarthroplasty with a subsequent loose femoral component. This anteroposterior radiograph shows a >2 mm lucency at the proximal femoral component (open arrow), which indicates loosening. Note the normal native acetabulum (arrow); the adjacent lucency between the acetabulum and the acetabular cup represents the acetabular hyaline cartilage, which is characteristic of a bipolar hemiarthroplasty. Slight superomedial narrowing between the acetabular cup and the native acetabulum indicates cartilage thinning. |
 | Media file 49: Image from a patient who had a cementless total hip arthroplasty with a subsequent loose femoral component. This anteroposterior radiograph shows a >2 mm lucency (arrow) around the femoral stem due to an abnormal distal toggling motion. Note the presence of sclerosis at the femoral stem tip, which is termed pedestal formation. |
 | Media file 50: This anteroposterior radiograph shows the numbered femoral and acetabular zones that are used to describe the location of a periprosthetic lucency. |
 | Media file 51: This lateral hip radiograph shows the additional numbered femoral zones that are used to describe the location of a periprosthetic lucency. |
 | Media file 52: Image from a patient who had an infection following a cemented total hip arthroplasty. This frog-leg radiograph shows an abnormal lucency (arrows) at the cement-prosthesis interface. |
 | Media file 53: Image from a patient who had particle disease following a bipolar hemiarthroplasty. This anteroposterior radiograph shows an abnormal lucency (arrows) that surrounds the acetabular component. Note the asymmetric position of the femoral head (blue dashed circle), which indicates the underlying polyethylene wear of the acetabular component. |
 | Media file 54: Image from a patient who had particle disease following a bipolar hemiarthroplasty (same patient as in Image 53). This axial computed tomography scan (without intravenous contrast) shows destruction of the acetabulum (arrow). The bone has been replaced with soft tissue from aggressive granulomatosis. |
 | Media file 55: Hip arthrogram from a patient who had a total hip arthroplasty. This anteroposterior radiograph (after intra-articular injection of iodinated contrast medium) shows filling of the joint from the acetabular rim to the intertrochanteric line (arrows). The opacity that is seen around the acetabular component is cement. |
 | Media file 56: Image from a patient who had a cemented total hip arthroplasty with subsequent loosening of the prosthesis. This anteroposterior radiograph (after intra-articular administration of iodinated contrast medium) shows abnormal contrast extension deep to the acetabular cup and beyond the intertrochanteric line (arrows) at the bone-cement interface. |
 | Media file 57: Image of the femoral component from a patient who had a cemented total hip arthroplasty. This anteroposterior radiograph (after intra-articular iodinated contrast injection) shows extension of intra-articular contrast medium into the iliopsoas bursa (arrow). |
 | Media file 58: Image of the femoral component from a patient who had a cemented total hip arthroplasty (same patient as in Image 57). This lateral radiograph shows intra-articular contrast medium filling the iliopsoas bursa (arrow) anterior to the hip joint. |
 | Media file 59: Image from a patient who had a cemented total hip arthroplasty. This anteroposterior radiograph (after intra-articular iodinated contrast injection) shows filling of an irregular trochanteric bursa (arrow). |
 | Media file 60: Image of the femoral component from a patient who had a cemented total hip arthroplasty. This coronal multiplanar reformatted computed tomography scan shows a soft-tissue abscess (arrow) extending from the distal prosthesis. Note the subsidence of the femoral component. |
 | Media file 61: Image from a patient who had a total hip arthroplasty. This axial T1-weighted magnetic resonance image shows the distended iliopsoas bursa is isointense relative to muscle (arrow). Note the signal void in the femur from the metal prosthesis. |
 | Media file 62: Image from a patient who had a total hip arthroplasty (same patient as in Image 61). This T2-weighted, fat-saturated, fast-spin-echo magnetic resonance image shows heterogeneous distention of the iliopsoas bursa (arrow). |
 | Media file 63: Image from a patient who had a normal total hip arthroplasty. This ultrasonogram is longitudinal to the femoral neck (Neck) and shows the hyperechoic surface (arrows) of the metal femoral head (H) and neck of the prosthesis, as well as posterior reverberation artifacts (between the open arrows). Note the hyperechoicity and shadowing of the native acetabulum (Acet) and the femur. The left side of the image is proximal; the right side is distal. |
 | Media file 64: Image from a patient who had a bipolar hemiarthroplasty. This ultrasonogram is longitudinal to the femoral neck (Neck) and shows a hypoechoic effusion (arrow) that is superficial to the femoral neck. Note the femoral head (H) and acetabular cup (Cup) of the prosthesis. The left side of image is proximal; the right side is distal. |
 | Media file 65: Image from a patient who had a total hip arthroplasty with subsequent joint infection. This ultrasonogram is longitudinal to the femoral neck (N) and shows a hypoechoic effusion (arrow) anterior to the femoral neck. Note the acetabular cup (C). The left side of the image is proximal; the right side is distal. |
 | Media file 66: Image from a patient who had a total hip arthroplasty. This ultrasonogram is longitudinal to the femoral neck (Neck) and shows a hypoechoic synovitis (arrows) that is superficial to the head (Head) and neck of the prosthesis. The left side of the image is proximal; the right side is distal. Acet = the native acetabulum. |
 | Media file 67: Image from a patient who had a total hip arthroplasty. This ultrasonogram is anterolateral to the hip arthroplasty and shows a hypoechoic and heterogeneous soft-tissue abscess (arrow). Note the increased through-transmission deep to abscess. |
 | Media file 68: Image from a patient who had total hip arthroplasty with subsequent infection of the endoprosthesis. This coronal ultrasonogram of the left thigh is longitudinal to the femur (Femur) and shows anechoic fluid (arrows) adjacent to the prosthesis (Arthroplasty) and native femur. Note that the posterior reverberation artifacts (between the open arrows) from the metal prosthesis occur away from the transducer and do not obscure the overlying fluid collection. The native femur demonstrates posterior shadowing. |
 | Media file 69: Image from a patient who had a total hip arthroplasty with subsequent infection. This ultrasonogram is longitudinal to the femoral neck (Neck) and shows the presence of hypoechoic infected fluid (arrows) extending beyond the head (H) and neck of the prosthesis over the native femur. The left side of the image is proximal; the right side is distal. |
 | Media file 70: Image from a patient who had a total hip arthroplasty with a subsequent thickened iliopsoas bursa. This ultrasonogram is longitudinal to the femoral neck and shows abnormal hypoechoic tissue (arrow) in the region of the iliopsoas bursa between the iliopsoas tendon (I) and femoral head (H) of the prosthesis. Ultrasound-guided anesthetic injection of this tissue relieved the patient's symptoms. C = acetabular cup; N = femoral neck of the prosthesis. The left side of the image is proximal; the right side is distal. |
 | Media file 71: Bone scan from an asymptomatic patient following a total hip arthroplasty (<1 y postoperative). This delayed image shows mild radionuclide uptake (arrow) around the prosthesis. |
 | Media file 72: Bone scan from an asymptomatic patient following a total hip arthroplasty (>1 y postoperative). This delayed image shows no significant radionuclide uptake around the femoral prosthesis. |
 | Media file 73: Bone scan from a patient who had a total hip arthroplasty with a subsequent loose component. This image shows abnormal tracer uptake at the greater tuberosity, femoral stem, and acetabulum. |
 | Media file 74: Bone scan from a patient who had a total hip arthroplasty and a subsequent femoral fracture. This delayed scan shows focal tracer uptake medial to the femoral stem (arrow). |
 | Media file 75: Radiograph from a patient with particle disease (aggressive granulomatosis). Note the extensive lucencies around the acetabular component of the hip. |
 | Media file 76: The sclerotic line on this radiograph represents normal bone condensation of the acetabulum, whereas the lucency represents the adjacent hyaline cartilage. The presence of these findings indicates no surgical alteration of the acetabulum has occurred; therefore, the prosthesis is not a total hip arthroplasty. |
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 Multimedia: Hip Replacement |
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References
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Further Reading
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Keywords
hip arthroplasty, hip prosthesis, THR, THA, heterotopic ossification, particle disease, periprosthetic lucency, aggressive granulomatosis, hemiarthroplasty, acetabulum, methylmethacrylate, metal-on-metal articulation, metal-on-metal arthroplasty, cemented component, cementless component, joint aspiration
