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Value of multidetector computed tomography for the differentiation of delayed aseptic and septic complications after total hip arthroplasty

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Abstract

Objective

The differentiation between delayed aseptic and septic complications of total hip arthroplasty is crucial to allow appropriate surgical planning and timely antimicrobial treatment. The aim of this study was to investigate the utility of multidetector computed tomography (CT) findings to diagnose aseptic mechanical loosening, granulomatous reaction, and periprosthetic joint infection in patients who underwent total hip arthroplasty before revision surgery.

Materials and methods

Ninety-six consecutive patients with a clinical suspicion of periprosthetic complications underwent revision surgery over an 8-year period. All patients had been evaluated preoperatively using multidetector CT without contrast media. Two blinded musculoskeletal radiologists reviewed multidetector CT images, including periprosthetic soft-tissue accumulation, prosthetic acetabular malposition, periprosthetic osteolysis, enlarged iliac lymph nodes, and heterotopic ossification. Risk factors for aseptic and septic loosening were identified using multivariate analysis.

Results

Multidetector CT-related variables independently associated with periprosthetic joint infection were high periprosthetic soft-tissue accumulation, periprosthetic osteolysis without expansile periosteal reaction and enlarged iliac lymph nodes. On the other hand, the absence of the following radiological signs: low or high periprosthetic soft-tissue accumulation, mild or severe periprosthetic osteolysis, and enlarged iliac lymph nodes, were predictors of aseptic mechanical loosening. Low periprosthetic soft-tissue accumulation, severe periprosthetic osteolysis with expansile periosteal reaction, and mild acetabular malposition were significant variables associated with granulomatosis.

Conclusion

Multidetector CT findings are useful to differentiate between aseptic and septic complications before revision surgery. The presence of osteolysis with expansile periosteal reaction appeared to be a time-dependent variable.

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Acknowledgements

The authors thank Albert Dalmau-Bueno for help in the statistical analysis of data and Marta Pulido, MD, for editing the manuscript and for editorial assistance.

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Authors and Affiliations

  1. Department of Radiology, Hospital Clinic, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain

    Jaime Isern-Kebschull, Xavier Tomas & Ana Isabel García-Díez

  2. Department of Infectious Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain

    Laura Morata & Alex Soriano

  3. Department of Traumatology and Orthopedic Surgery, University of Barcelona, Barcelona, Spain

    Ignacio Moya

  4. Statistical Unit, Statistics and Methodological Support Service, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    José Ríos

Authors
  1. Jaime Isern-Kebschull
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  2. Xavier Tomas
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Correspondence to Jaime Isern-Kebschull.

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Written informed consent was obtained from all participants.

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The study was approved by the Institutional Review Board (study protocol 2017/0331).

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Retrospective.

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Performed at one institution.

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Isern-Kebschull, J., Tomas, X., García-Díez, A.I. et al. Value of multidetector computed tomography for the differentiation of delayed aseptic and septic complications after total hip arthroplasty. Skeletal Radiol 49, 893–902 (2020). https://doi.org/10.1007/s00256-019-03355-1

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  • DOI: https://doi.org/10.1007/s00256-019-03355-1

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