2.2 Radiological Assessment & Clinical Indications for THR
Understand radiological assessment of the hip
Understand radiological assessment of the hip
What has been the easiest and fastest method to vsualise skeletal disorders and injuries?
Conventional plain radiographic films (x-rays)
Describe two other imaging techniques for visualise skeletal disorders than x-rays.
- CT (Conventional Tomography
- US (Ultrasonography
- MRI (Magnetic Resonance Imaging)
When taking a plane A/P radiograph of the pelvis and with the patient supine, how should the feet be positioned, in order to get a good indication of CCD angle?
15° internal rotation
Bei der Planung weden beide Trochiander benötigt
Which anatomical landmarks and features are used to evaluate hip radiographs?
- Kohler's line
- Shenton's line
What is the significance of Ward's triangle?
This area is the weakest part of the femoral neck.
What is a break or distortion of Shenton's line an indication of?
indicates a change in offset or leg length.
Developmental Dysplasia of the Hip (DDH) describes a large group of hip abnormalities.
What might this be due to?
occur due to developmental problems from birth or in childhood or in juveniles.
What is Slipped Capital Femoral Epiphysis.
Who is affected by this condition?
is a disorder of adolescence in which the femoral head gradually slips
- posteriorly
- medially
- inferiorly
Boy are affeted more often than girls (overwight)
What is AVN (Avascular Necrosis)?
What is core decompression?
dead bone tissue due to insufficient blood supply.
Core decomprssion: necrotic lesion in the femoral head is removed from inside the head through the neck
What are the possible causes of AVN in the hip joint?
- Excessive alcohol intake
- steroid medicatios
- blood dyscrasia
- doses of immunosuppressive drugs
- renal or cardiac tranplants
Differentiate between intracapsular and extracapsular fractures of the neck of the femur.
Intracapsular: Fracture in neck or head
Extracpsular: Fracture bellow the neck
What classification systems can be used to describe different degrees of fracture to the neck of the femur?
- Garden's type 1-4
- Pauwel's type 1-3
What are the five classic radiographic hallmarks of primary osteoarthritis?
- Joint space narrowing
- Osteophytes
- Bone cysts
- Subchondral sclerosis
- Avascular necrosis
How does the radiographic appearance of a rheumatiod arthritis hip differ from that of an osteoarthritis hip?
RA: joint space narrowing
central migration (protrusion)
seldom shows osteophytes or large cyste
Describe the indications and contraindications for hemiarthroplasty?
is not indicated in hips with weak acetabulii such as osteoporosis, rheumatoid arthrits other pathologies
indicated for unstable fracture or more than 24 hours old, biologically elderly persons
What are the contraindications for total hip arthroplasty?
- previous infection
Why do radiographic templates feature magnified (x10, 15 and 20 percent) implant images?
due to the divergence of the x-ray beam and the amount of magnification on the distance between the skeleton and the x-ray film
What are the optimal radiographs to obtain for templating the femur for a total hip prosthesis?
- both extremities are place in 15° of internal rotation
- x-ray beam is centred on the symphysis pubis
- demonstrate the acetabular
Which classification system can be used to identify specific areas of the femur-cement-bone interface?
7 categories arround the femur stem
What are the causes of radiolucent lies at the prosthesis to bone and cement to bone interface?
indicate a change in bone density or a space between the implant and the surrounding bone or the cement mantle and the bone, which may indicate loosning of the components.
Which classification system can be used to identify specific areas of the acetabulum-cement bone interface?
3 categories arround the acetabulum
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What has been the easiest and fastest method to vsualise skeletal disorders and injuries?
Conventional plain radiographic films (x-rays)
Describe two other imaging techniques for visualise skeletal disorders than x-rays.
- CT (Conventional Tomography
- US (Ultrasonography
- MRI (Magnetic Resonance Imaging)
When taking a plane A/P radiograph of the pelvis and with the patient supine, how should the feet be positioned, in order to get a good indication of CCD angle?
15° internal rotation
Bei der Planung weden beide Trochiander benötigt
Which anatomical landmarks and features are used to evaluate hip radiographs?
- Kohler's line
- Shenton's line
What is the significance of Ward's triangle?
This area is the weakest part of the femoral neck.
What is a break or distortion of Shenton's line an indication of?
indicates a change in offset or leg length.
Developmental Dysplasia of the Hip (DDH) describes a large group of hip abnormalities.
What might this be due to?
occur due to developmental problems from birth or in childhood or in juveniles.
What is Slipped Capital Femoral Epiphysis.
Who is affected by this condition?
is a disorder of adolescence in which the femoral head gradually slips
- posteriorly
- medially
- inferiorly
Boy are affeted more often than girls (overwight)
What is AVN (Avascular Necrosis)?
What is core decompression?
dead bone tissue due to insufficient blood supply.
Core decomprssion: necrotic lesion in the femoral head is removed from inside the head through the neck
What are the possible causes of AVN in the hip joint?
- Excessive alcohol intake
- steroid medicatios
- blood dyscrasia
- doses of immunosuppressive drugs
- renal or cardiac tranplants
Differentiate between intracapsular and extracapsular fractures of the neck of the femur.
Intracapsular: Fracture in neck or head
Extracpsular: Fracture bellow the neck
What classification systems can be used to describe different degrees of fracture to the neck of the femur?
- Garden's type 1-4
- Pauwel's type 1-3
What are the five classic radiographic hallmarks of primary osteoarthritis?
- Joint space narrowing
- Osteophytes
- Bone cysts
- Subchondral sclerosis
- Avascular necrosis
How does the radiographic appearance of a rheumatiod arthritis hip differ from that of an osteoarthritis hip?
RA: joint space narrowing
central migration (protrusion)
seldom shows osteophytes or large cyste
Describe the indications and contraindications for hemiarthroplasty?
is not indicated in hips with weak acetabulii such as osteoporosis, rheumatoid arthrits other pathologies
indicated for unstable fracture or more than 24 hours old, biologically elderly persons
What are the contraindications for total hip arthroplasty?
- previous infection
Why do radiographic templates feature magnified (x10, 15 and 20 percent) implant images?
due to the divergence of the x-ray beam and the amount of magnification on the distance between the skeleton and the x-ray film
What are the optimal radiographs to obtain for templating the femur for a total hip prosthesis?
- both extremities are place in 15° of internal rotation
- x-ray beam is centred on the symphysis pubis
- demonstrate the acetabular
Which classification system can be used to identify specific areas of the femur-cement-bone interface?
7 categories arround the femur stem
What are the causes of radiolucent lies at the prosthesis to bone and cement to bone interface?
indicate a change in bone density or a space between the implant and the surrounding bone or the cement mantle and the bone, which may indicate loosning of the components.
Which classification system can be used to identify specific areas of the acetabulum-cement bone interface?
3 categories arround the acetabulum
