DOI: 10.1148/rg.235035059
Joint Arthroplasties and Prostheses1
Mihra S. Taljanovic, MD,
Marci D. Jones, MD,
Tim B. Hunter, MD,
James B. Benjamin, MD,
John T. Ruth, MD,
Andrew W. Brown, MD and
Joseph E. Sheppard, MD
1 From the Departments of Radiology (M.S.T., T.B.H.) and Orthopaedic Surgery (M.D.J., J.B.B., J.T.R., A.W.B., J.E.S.), University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 24506, Tucson, AZ 85724-5067. Received March 10, 2003; revision requested March 24 and received April 18; accepted April 23. Address correspondence to M.S.T. (e-mail: mihrat@radiology.arizona.edu).
View larger version (112K):
[in a new window]
|
Figure 1. Anteroposterior radiograph of the proximal left humerus shows a shoulder prosthesis (Biomodular; Biomet, Warsaw, Ind) and skin staples from recent hemiarthroplasty.
|
|
View larger version (119K):
[in a new window]
|
Figure 2. Anteroposterior radiograph of the left shoulder shows a polyethylene (keeled) glenoid component (Total Polyethylene glenoid; DePuy, Warsaw, Ind) used in a total shoulder arthroplasty.
|
|
View larger version (117K):
[in a new window]
|
Figure 3a. Anteroposterior (a) and lateral (b) radiographs of the right elbow show a stainless steel radial head prosthesis (Evolve; Wright Medical, Arlington, Tenn). An overlying brace is seen in the frontal view. The patient underwent arthroplasty for a severely comminuted radial head fracture.
|
|
View larger version (103K):
[in a new window]
|
Figure 3b. Anteroposterior (a) and lateral (b) radiographs of the right elbow show a stainless steel radial head prosthesis (Evolve; Wright Medical, Arlington, Tenn). An overlying brace is seen in the frontal view. The patient underwent arthroplasty for a severely comminuted radial head fracture.
|
|
View larger version (65K):
[in a new window]
|
Figure 4a. Anteroposterior (a) and lateral (b) radiographs of the left elbow show a cemented semiconstrained total elbow arthroplasty prosthesis (Discovery elbow; Biomet). A bone graft (arrow in b) taken from the resected trochlea is usually placed between the humeral shaft and the flange to enhance fixation and the stability of the implant. A cerclage wire is also placed about the fractured proximal ulna. The proximal portion of the radial intramedullary rod is seen on the anteroposterior view.
|
|
View larger version (85K):
[in a new window]
|
Figure 4b. Anteroposterior (a) and lateral (b) radiographs of the left elbow show a cemented semiconstrained total elbow arthroplasty prosthesis (Discovery elbow; Biomet). A bone graft (arrow in b) taken from the resected trochlea is usually placed between the humeral shaft and the flange to enhance fixation and the stability of the implant. A cerclage wire is also placed about the fractured proximal ulna. The proximal portion of the radial intramedullary rod is seen on the anteroposterior view.
|
|
View larger version (94K):
[in a new window]
|
Figure 5a. Anteroposterior (a) and lateral (b) radiographs of the right elbow show a failed cemented semiconstrained total elbow arthroplasty (Coonrad Morey; Zimmer, Warsaw, Ind). There is loosening of both components (note extensive osteolysis about the cemented humeral stem), bone remodeling along the anterior distal humeral shaft, and a periprosthetic ulnar shaft fracture about the distal component.
|
|
View larger version (99K):
[in a new window]
|
Figure 5b. Anteroposterior (a) and lateral (b) radiographs of the right elbow show a failed cemented semiconstrained total elbow arthroplasty (Coonrad Morey; Zimmer, Warsaw, Ind). There is loosening of both components (note extensive osteolysis about the cemented humeral stem), bone remodeling along the anterior distal humeral shaft, and a periprosthetic ulnar shaft fracture about the distal component.
|
|
View larger version (114K):
[in a new window]
|
Figure 6. Anteroposterior radiograph of the left wrist shows a four-bone partial carpal fusion with a spider plate and screw device (KMI; San Diego, Calif). The patient underwent scaphoid resection because of previous fracture nonunion and proximal scaphoid pole avascular necrosis. Note the lucent area in the distal radius secondary to previous bone graft donor site.
|
|
View larger version (93K):
[in a new window]
|
Figure 7a. Anteroposterior (a) and lateral (b) radiographs of the right wrist show a Steinman rod wrist arthrodesis in a patient with advanced rheumatoid arthritis. Fixation of the third PIP joint with a Kirshner wire tension band fixation is also evident.
|
|
View larger version (63K):
[in a new window]
|
Figure 7b. Anteroposterior (a) and lateral (b) radiographs of the right wrist show a Steinman rod wrist arthrodesis in a patient with advanced rheumatoid arthritis. Fixation of the third PIP joint with a Kirshner wire tension band fixation is also evident.
|
|
View larger version (95K):
[in a new window]
|
Figure 8a. Anteroposterior (a) and lateral (b) radiographs of the left wrist in a patient with advanced rheumatoid arthritis show silicone prostheses and associated titanium grommets (Swanson finger joint implant; Wright Medical) in both the wrist and first MCP joints, as well as a Herbert screw (Zimmer) across the fused first interphalangeal joint. The wrist prosthesis is subluxed.
|
|
View larger version (87K):
[in a new window]
|
Figure 8b. Anteroposterior (a) and lateral (b) radiographs of the left wrist in a patient with advanced rheumatoid arthritis show silicone prostheses and associated titanium grommets (Swanson finger joint implant; Wright Medical) in both the wrist and first MCP joints, as well as a Herbert screw (Zimmer) across the fused first interphalangeal joint. The wrist prosthesis is subluxed.
|
|
View larger version (79K):
[in a new window]
|
Figure 9a. Anteroposterior (a) and lateral (b) radiographs of the right wrist demonstrate a Volz II total wrist prosthesis (DePuy). Note failure of the distal component, which is protruding through the dorsal aspect of the third metacarpal bone.
|
|
View larger version (79K):
[in a new window]
|
Figure 9b. Anteroposterior (a) and lateral (b) radiographs of the right wrist demonstrate a Volz II total wrist prosthesis (DePuy). Note failure of the distal component, which is protruding through the dorsal aspect of the third metacarpal bone.
|
|
View larger version (121K):
[in a new window]
|
Figure 10. Anteroposterior view of the left wrist shows a Universal II total wrist prosthesis (KMI). (Courtesy of Mark Mellinger, MD, Gainesville, Fla.)
|
|
View larger version (75K):
[in a new window]
|
Figure 11a. (a, b) Anteroposterior (a) and oblique (b) radiographs of the right hand in a patient with rheumatoid arthritis show multiple devices implanted for wrist and first MCP joint fusion: Swanson silicone devices for the MCP joints with circumferential titanium grommets (note abnormal orientation of the distal grommet of the second MCP joint), silicone elastomere capping of the distal ulna (Swanson), fusion of the third through fifth PIP joints with Acutrak screws (Acutrak screw system; Acumed, Hillsboro, Ore), and an additional Kirshner wire through the fourth PIP joint. (c) Anteroposterior radiograph of the same hand after removal of the failed distal grommet from the second MCP joint and the Kirshner wire.
|
|
View larger version (68K):
[in a new window]
|
Figure 11b. (a, b) Anteroposterior (a) and oblique (b) radiographs of the right hand in a patient with rheumatoid arthritis show multiple devices implanted for wrist and first MCP joint fusion: Swanson silicone devices for the MCP joints with circumferential titanium grommets (note abnormal orientation of the distal grommet of the second MCP joint), silicone elastomere capping of the distal ulna (Swanson), fusion of the third through fifth PIP joints with Acutrak screws (Acutrak screw system; Acumed, Hillsboro, Ore), and an additional Kirshner wire through the fourth PIP joint. (c) Anteroposterior radiograph of the same hand after removal of the failed distal grommet from the second MCP joint and the Kirshner wire.
|
|
View larger version (78K):
[in a new window]
|
Figure 11c. (a, b) Anteroposterior (a) and oblique (b) radiographs of the right hand in a patient with rheumatoid arthritis show multiple devices implanted for wrist and first MCP joint fusion: Swanson silicone devices for the MCP joints with circumferential titanium grommets (note abnormal orientation of the distal grommet of the second MCP joint), silicone elastomere capping of the distal ulna (Swanson), fusion of the third through fifth PIP joints with Acutrak screws (Acutrak screw system; Acumed, Hillsboro, Ore), and an additional Kirshner wire through the fourth PIP joint. (c) Anteroposterior radiograph of the same hand after removal of the failed distal grommet from the second MCP joint and the Kirshner wire.
|
|
View larger version (119K):
[in a new window]
|
Figure 12. Posteroanterior radiograph shows the trapezial part of a wrist implant (Titanium; Wright Medical) that is fractured at the radial site. The patient had undergone trapeziometacarpal arthroplasty.
|
|
View larger version (124K):
[in a new window]
|
Figure 13. Posteroanterior radiograph shows Swanson silicone implants in the second through fifth MCP joints in a patient with rheumatoid arthritis who underwent wrist arthroplasty.
|
|
View larger version (80K):
[in a new window]
|
Figure 14a. Anteroposterior (a) and lateral (b) radiographs of the right hip show a cemented unipolar hip hemiarthroplasty (endoprosthesis) (Zimmer). Note the collar abutting the calcar (arrow).
|
|
View larger version (80K):
[in a new window]
|
Figure 14b. Anteroposterior (a) and lateral (b) radiographs of the right hip show a cemented unipolar hip hemiarthroplasty (endoprosthesis) (Zimmer). Note the collar abutting the calcar (arrow).
|
|
View larger version (98K):
[in a new window]
|
Figure 15a. Anteroposterior (a) and lateral (b) radiographs of the right hip show a bipolar hip hemiarthroplasty with a cemented femoral component (Zimmer).
|
|
View larger version (97K):
[in a new window]
|
Figure 15b. Anteroposterior (a) and lateral (b) radiographs of the right hip show a bipolar hip hemiarthroplasty with a cemented femoral component (Zimmer).
|
|
View larger version (77K):
[in a new window]
|
Figure 16. Anteroposterior radiograph of the right hip shows a bipolar revision arthroplasty (Solution fully porous coated; DePuy) with a long femoral stem, onlay allograft, and cerclage wires. The revision arthroplasty was performed after periprosthetic fracture of the femoral shaft.
|
|
View larger version (79K):
[in a new window]
|
Figure 17a. Anteroposterior (a) and lateral (b) radiographs of the right hip show a hybrid total hip prosthesis with cementless acetabular and cemented femoral components (CPCS; Smith & Nephew, Memphis, Tenn).
|
|
View larger version (86K):
[in a new window]
|
Figure 17b. Anteroposterior (a) and lateral (b) radiographs of the right hip show a hybrid total hip prosthesis with cementless acetabular and cemented femoral components (CPCS; Smith & Nephew, Memphis, Tenn).
|
|
View larger version (26K):
[in a new window]
|
Figure 18. Diagram illustrates the radiographic zones for acetabular and femoral prostheses. The seven zones are explained in text. (Reprinted, with permission, from reference 4.)
|
|
View larger version (109K):
[in a new window]
|
Figure 19. Anteroposterior radiograph of the left hip shows an acetabular reconstruction ring placed during total hip revision arthroplasty (Smith & Nephew). Note postoperative overlying drain.
|
|
View larger version (129K):
[in a new window]
|
Figure 20. Anteroposterior radiograph of the left hip shows a custom tumor prosthesis (saddle) (Waldemar link; Hamburg, Germany) in a patient with extensive multiple myeloma lesions involving the left acetabulum and other pelvic bones.
|
|
View larger version (115K):
[in a new window]
|
Figure 21a. Anteroposterior (a) and lateral (b) radiographs of the right knee show a unicompartmental prosthesis of the medial compartment (Miller Galante; Zimmer).
|
|
View larger version (132K):
[in a new window]
|
Figure 21b. Anteroposterior (a) and lateral (b) radiographs of the right knee show a unicompartmental prosthesis of the medial compartment (Miller Galante; Zimmer).
|
|
View larger version (92K):
[in a new window]
|
Figure 22a. Anteroposterior (a), lateral (b), and patellofemoral (c) radiographs of the left knee show a unicompartmental patellofemoral prosthesis.
|
|
View larger version (120K):
[in a new window]
|
Figure 22b. Anteroposterior (a), lateral (b), and patellofemoral (c) radiographs of the left knee show a unicompartmental patellofemoral prosthesis.
|
|
View larger version (32K):
[in a new window]
|
Figure 22c. Anteroposterior (a), lateral (b), and patellofemoral (c) radiographs of the left knee show a unicompartmental patellofemoral prosthesis.
|
|
View larger version (124K):
[in a new window]
|
Figure 23a. Anteroposterior (a) and lateral (b) radiographs of the right knee show a cruciate-retaining three-part total knee prosthesis (PFC; Johnson & Johnson, DePuy).
|
|
View larger version (139K):
[in a new window]
|
Figure 23b. Anteroposterior (a) and lateral (b) radiographs of the right knee show a cruciate-retaining three-part total knee prosthesis (PFC; Johnson & Johnson, DePuy).
|
|
View larger version (108K):
[in a new window]
|
Figure 24a. Anteroposterior (a) and lateral (b) radiographs of the left knee show a cemented cruciate-substituting total knee prosthesis and resurfacing of the patella (Genesis II; Smith & Nephew). Note the large "box" of the femoral component (arrow).
|
|
View larger version (110K):
[in a new window]
|
Figure 24b. Anteroposterior (a) and lateral (b) radiographs of the left knee show a cemented cruciate-substituting total knee prosthesis and resurfacing of the patella (Genesis II; Smith & Nephew). Note the large "box" of the femoral component (arrow).
|
|
View larger version (72K):
[in a new window]
|
Figure 25a. (a, b) Anteroposterior (a) and lateral (b) radiographs of the left knee show a cruciate-retaining total knee prosthesis with resurfacing of the patella (AMK; DePuy). Lytic lesions are seen in the medial femoral condyle and in the patella, as well as asymmetric appearance of tibial tray polyethylene (arrow), findings consistent with small particle disease. Note a moderate-size dense joint effusion on the lateral view. (c, d) Anteroposterior (c) and lateral (d) radiographs of the same knee demonstrate bone grafting of the medial femoral condyle and the patella and revision of the polyethylene liner. Note the polyethylene locking mechanism clip, which locks the tibial polyethylene into the tibial base plate (arrow).
|
|
View larger version (76K):
[in a new window]
|
Figure 25b. (a, b) Anteroposterior (a) and lateral (b) radiographs of the left knee show a cruciate-retaining total knee prosthesis with resurfacing of the patella (AMK; DePuy). Lytic lesions are seen in the medial femoral condyle and in the patella, as well as asymmetric appearance of tibial tray polyethylene (arrow), findings consistent with small particle disease. Note a moderate-size dense joint effusion on the lateral view. (c, d) Anteroposterior (c) and lateral (d) radiographs of the same knee demonstrate bone grafting of the medial femoral condyle and the patella and revision of the polyethylene liner. Note the polyethylene locking mechanism clip, which locks the tibial polyethylene into the tibial base plate (arrow).
|
|
View larger version (128K):
[in a new window]
|
Figure 25c. (a, b) Anteroposterior (a) and lateral (b) radiographs of the left knee show a cruciate-retaining total knee prosthesis with resurfacing of the patella (AMK; DePuy). Lytic lesions are seen in the medial femoral condyle and in the patella, as well as asymmetric appearance of tibial tray polyethylene (arrow), findings consistent with small particle disease. Note a moderate-size dense joint effusion on the lateral view. (c, d) Anteroposterior (c) and lateral (d) radiographs of the same knee demonstrate bone grafting of the medial femoral condyle and the patella and revision of the polyethylene liner. Note the polyethylene locking mechanism clip, which locks the tibial polyethylene into the tibial base plate (arrow).
|
|
View larger version (126K):
[in a new window]
|
Figure 25d. (a, b) Anteroposterior (a) and lateral (b) radiographs of the left knee show a cruciate-retaining total knee prosthesis with resurfacing of the patella (AMK; DePuy). Lytic lesions are seen in the medial femoral condyle and in the patella, as well as asymmetric appearance of tibial tray polyethylene (arrow), findings consistent with small particle disease. Note a moderate-size dense joint effusion on the lateral view. (c, d) Anteroposterior (c) and lateral (d) radiographs of the same knee demonstrate bone grafting of the medial femoral condyle and the patella and revision of the polyethylene liner. Note the polyethylene locking mechanism clip, which locks the tibial polyethylene into the tibial base plate (arrow).
|
|
View larger version (75K):
[in a new window]
|
Figure 26a. Anteroposterior (a), mortise (b), and lateral (c) radiographs of the right ankle show a fixed-bearing porous-coated total ankle prosthesis (early postoperative phase), with a partially conforming articulation (Agility; DePuy).
|
|
View larger version (88K):
[in a new window]
|
Figure 26b. Anteroposterior (a), mortise (b), and lateral (c) radiographs of the right ankle show a fixed-bearing porous-coated total ankle prosthesis (early postoperative phase), with a partially conforming articulation (Agility; DePuy).
|
|
View larger version (97K):
[in a new window]
|
Figure 26c. Anteroposterior (a), mortise (b), and lateral (c) radiographs of the right ankle show a fixed-bearing porous-coated total ankle prosthesis (early postoperative phase), with a partially conforming articulation (Agility; DePuy).
|
|
View larger version (137K):
[in a new window]
|
Figure 27a. Anteroposterior (a) and lateral (b) radiographs of the left ankle show a fixed-bearing porous-coated total ankle prosthesis, with a partially conforming articulation (Agility; DePuy). Note fused tibiofibular syndesmosis (late postoperative phase).
|
|
View larger version (109K):
[in a new window]
|
Figure 27b. Anteroposterior (a) and lateral (b) radiographs of the left ankle show a fixed-bearing porous-coated total ankle prosthesis, with a partially conforming articulation (Agility; DePuy). Note fused tibiofibular syndesmosis (late postoperative phase).
|
|
View larger version (118K):
[in a new window]
|
Figure 28. Anteroposterior radiograph of the right forefoot shows a first metatarsophalangeal joint prosthesis (Swanson-silicone implant with titanium grommets).
|
|
Copyright © 2003 by the Radiological Society of North America.
