Fact-sheet: Prosthetic joint injection
Updated on 09/30/2019 at 4:53 PM
Note : 0/10
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Definition
Hip arthroplasty: 150,000/year in France
Main indication: Hip osteoarthritis
Loosening: loss of fixation of a cemented prosthesis or absence or secondary loss of osseointegration of an uncemented prosthesis
Loosening may be of the following origin:
- septic
- mechanical
- secondary to a granulomatous reaction
Clinical features
- Acute infection, immediate postoperative, exceptional
- Secondary: indolent course (rare, 0.5 to 1%), gradually developing pain or discomfort, fever
- Late: very indolent course over several years, flaring up in the setting of a general decline in the patient's condition
Laboratory findings
Biological inflammatory syndrome, leukocytosis, elevated ESR and CRP
Radiography
Outside the weight-bearing zones:
- Multifocal or multilamellar periosteal reaction
- Ill-defined, poorly circumscribed area of osteolysis or bone erosion
- Bipolar (multifocal) pattern
- Evolution over time
Ultrasound
- Intra-articular effusion
- Soft tissue collections
- Fistulas
- Hyperemia around remodeled bone cortex on CT indicates an active process
CT
Bone changes:
Outside weight-bearing areas:
- Multifocal or multilamellar periosteal reaction
- Ill-defined osteolytic or erosive bone lesion with poorly circumscribed margins
- Bipolar (multifocal) involvement
- Change over time
Soft tissue changes:
- Joint effusion
- Soft tissue collections
- Fistulas
MRI
Study markedly degraded by artifact from prosthetic hardware:
- Soft tissue collection
- Periprosthetic effusion
- Bursitis
Nuclear medicine
Increased uptake at the prosthesis
Differential diagnosis
Non-septic or granulomatous loosening
