Imaging of Prosthetic Joints: A Combined Radiological and Clinical Perspective

185 Pages·2014·4.975 MB·English

by  Angela Oranger, Graziana Colaianni, Maria Grano (auth.), Carlina V. Albanese, Carlo Faletti (eds.)

Carlina V. Albanese
Carlo Faletti Editors
Imaging of
Prosthetic Joints
A Combined Radiological
and Clinical Perspective
Imaging of Prosthetic Joints
Carlina V. Albanese Carlo Faletti
•
Editors
Imaging of Prosthetic
Joints
A Combined Radiological
and Clinical Perspective
123
Editors
Carlina V.Albanese CarloFaletti
Department of RadiologicalSciences Radiodiagnostica CTO
Oncology and Pathology AziendaOspedaliera Cittàdella Salute
Universityof RomeSapienza e dellaScienza diTorino
Rome Torino
Italy Italy
ISBN 978-88-470-5482-0 ISBN 978-88-470-5483-7 (eBook)
DOI 10.1007/978-88-470-5483-7
SpringerMilanHeidelbergNewYorkDordrechtLondon
LibraryofCongressControlNumber:2013954018
(cid:2)Springer-VerlagItalia2014
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This book is dedicated to Professor Roberto Passariello,
eminent radiologist and great teacher, who taught us with
humility and tenacity to face the hardest challenges
in research and in commitment to science
Preface
The concept of a book dedicated to imaging of prosthetic joint - a com-
bined radiological and clinical perspective arose from the work experi-
ences of the editors who carry out their profession of musculoskeletal
radiologists working closely with orthopaedic colleagues. The continu-
ous exchange,of technicalexperiences, of research and the professional
collaborations aimed at solving the different clinical and diagnostic
problems in the specific field of joint replacements have stimulated the
idea to write this book. The considerable improvements in surgical
techniques, in prosthetic biomaterials and design make joint replace-
ment a safe procedure. Nevertheless, a life long implant does not exist,
and early failures are registered in a small but significant number of
cases.Moreover,aconsistentnumberoftheremainingimplantscanlast
for more than 15 years, allowing the manifestation of bone aging pro-
cess such asbone loss and medullary enlargementwhich couldthreaten
alongersurvival.Consideringthelargenumberofpatientsinvolved,the
impact of the procedure on the quality of life, and the severe conse-
quences of implant failure, the monitoring of prostheses became man-
datoryinordertoimprovetheirlongevity.Thelongevityoftheimplants
depends on the achieved mechanical stability and on osseointegration
with the hosting bone, that is the interaction between the hosting bone
and the implant and the adapted surgical procedures.
Over the years we have witnessed extraordinary progress in this
fascinating field of medicine. Major advances have occurred at basic
science, clinical and diagnostic levels, technological development mate-
rial properties, design and fixation of articular prostheses and we have
incorporate them in this first edition.
The organization of the book into four sections reflects the several
basicscienceandclinicaldisciplinesthatcontributetothefield.Thefirst
section provides a fundamental introduction to the mechanism of
osseointegration, from the recent progress in the elucidation of the
uniquemolecularregulatorymechanismsofbonecellsandextracellular
matrix, to biomechanics and prosthetic osseointegration and material
implant.
The treatment of orthopedic diseases has changed considerably over
the past decades, allowing patients to live longer and to have better-
quality lives. The introduction of new biomaterials has contributed
vii
viii Preface
much to this success. The material properties and fixation methods of
joint implants is paramount to prostheses performances and their sur-
vivorship. The new developments in bearing surfaces and coating
materialsrepresenttheattempttobringjointprosthesestothenextlevel
and get a further increase as in performance as well in longevity by
decreasing the wear degradation and osseointegration problems.
The second section provides a dynamic view of the diagnostic tech-
niques indicated in the pre-operative surgery planning and in the post-
surgery surveillance of prosthetic survival. Imaging is required for the
initial assessment, routine follow-up and in patients with suspected
complications.
As joint replacement has become prevalent, a myriad of prostheses
became available. The radiological criteria for diagnosis of failure of
prosthesis may depend on the type of prostheses and technique used.
However, the imaging of complications of prostheses may be challeng-
ing.Fractures,dislocationsandmostcasesofaseptinglooseningcanbe
diagnosed with a combination of clinical and diagnostic techniques. In
theimmediatepost-operativeperiodaplainfilmisroutinelyperformed.
In the prosthesis follow-up the main purpose of the plain film is to
diagnose loosening of the prosthesis. MRI will often provide better
anatomicaldetailforpre-operativeplanning.MRIandCTareusefulfor
assessing the patients in case of complications, but are limited by the
presence of artefacts caused by the metallic prostheses, which may
degrade the imaging of the adjacent portions. The role of nuclear
medicine in the evaluation of painful joint replacement and in differ-
entiating the aseptic loosening from infection of the prosthesis is also
described.
This is the first book that includes both the most well known diag-
nostictechniquesusedforperiprostheticsurveillanceandalsotheDXA
method. In the last 25 years, due to an improvement in hardware and
software of dual-energy X-ray absorptiometry (DXA) there has been
increasing interest within the orthopedic community in the noninvasive
measurementofbonemineralmassandboneremodellingaroundmetal
joint prostheses in clinical practice and research. This interest has been
stimulated, in part, by the recognition and understanding that the sev-
eral diagnostic tools available in the clinical diagnosis of a failed
arthroplastyareneithersensitivenoraccurateforthediagnosisofearly
bone loss. Using the DXA technique, the amount of bone mass after
jointstemimplantationcanbedeterminedwithhighprecision,minimal
radiation exposure and negligible affection by metallic implants. The
relative chapter summarizes the technical aspects and clinical applica-
tions of periprosthetic DXA in the two common and most currently
well-accepted orthopedic applications such as after total hip and total
knee joints implant.
The third section summarizes the most common implants and sur-
gicaltechniquesusedinthehipandkneereplacementprocedureaswell
aswidelyusedpre-andpostoperativeimagingtechniques.Inorthopedic
surgery practice the use offoot, ankle, shoulder, elbow, wrist and hand
Preface ix
prosthesis has become more and more common over the past decades,
even if relatively few total arthroplasties are still performed each year
considering the total numbers of hip and knee implants. The several
types of implants and material, the potential complications and the
clinical indications of these joint implants are also included in the third
section.
Sectionfourcontainstheprogressthathasalsobeenmadeinclinical
practice. The potential use of different pharmacological compounds to
enhance periprosthetic bone quality and bone mass, thus to prevent
early implant failure, is described, as well as the different therapeutic
approachesthathavebeenproposedovertheyearsinexperimentaland
clinical studies to improve osseointegration of prosthetic implants. As
physical rehabilitation is extremely important in the overalloutcome of
any joint replacement surgery, particular importance has been given to
the chapter about post surgery rehabilitation. The goals of physical
therapy are to prevent contractures, improve patient education, and
strengthen muscles around the joint through controlled exercises.
Therefore,theuseofphysicaltherapiesisafundamentalsupport tothe
rehabilitative programs for the patient that under went surgical inter-
vention of joint prosthesis.
We hope that this volume will be a reference tool not only for spe-
cialists in the field, such as radiologists and orthopedists, but also for
medical students allowing them to expand their educational and scien-
tific interests as well as the interest in practical medicine.
The full credit for any educational benefit that this book may offer
goes to the many scientists who have captured their knowledge and
experience in this volume. They deserve our deepest gratitude for the
high quality of their contributions and their enthusiastic cooperation.
We would also express our sincere appreciation to all Editorialstafffor
their guidance and assistance in the preparation and publication of this
work.
Carlina V. Albanese
Carlo Faletti
Contents
Part I Cellular Elements, Bone Matrix, Bone Remodeling,
Osseointegration, Implant Material
1 Bone Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Angela Oranger, Graziana Colaianni and Maria Grano
2 Bone Matrix Proteins and Mineralization Process. . . . . . . 15
Roberto Tamma, Claudia Carbone and Silvia Colucci
3 Bone Remodeling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Giacomina Brunetti, Adriana Di Benedetto and Giorgio Mori
4 Biomechanics and Prosthetic Osseointegration. . . . . . . . . . 39
Oreste Moreschini and Simone Pelle
5 Material Implant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Ciro Villani and Alessandro Calistri
Part II Images Techniques, Conventional RX, CT, MR,
Bone Scintigraphy, Periprosthetic DXA
6 Role of Conventional RX, CT, and MRI
in the Evaluation of Prosthetic Joints . . . . . . . . . . . . . . . . 63
Carlo Masciocchi, Francesco Arrigoni and Antonio Barile
7 Role of Nuclear Medicine in Prosthesis Surveillance . . . . . 71
Mauro Liberatore
8 Periprosthetic DXA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Carlina V. Albanese
xi
xii Contents
Part III Prosthetic Joints of Foot and Ankle, Hip, Knee,
Shoulder, Elbow, Wrist and Hand
9 Foot and Ankle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Davide Edoardo Bonasia, Laura Bruno, Lorenzo Morino
and Raul Cerlon
10 Hip: Type of Prosthesis and Implantation Technique. . . . . 103
Alessandro Calistri, Lucian Lior Marcovici and Ciro Villani
11 Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Davide Edoardo Bonasia, Massimiliano Dragoni,
Federico Dettoni, Matteo Bruzzone, Corrado Bertolo
and Roberto Rossi
12 Shoulder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Umberto Mariotti, Pierorazio Motta and Piermario Tosco
13 Elbow Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Maddalena Bertolini, Francesco Giacalone and Italo Pontini
Part IV Drug Therapy, Bisphosphonate, Teriparatide
and Parathormone, Strontium Ranelate
14 Drug Therapy After Implant . . . . . . . . . . . . . . . . . . . . . . 151
Carlina V. Albanese
15 TBD: Postsurgery Rehabilitation. . . . . . . . . . . . . . . . . . . . 159
Valter Santilli, Andrea Bernetti and Massimiliano Mangone
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187