Around 5–6% of these THRs will undergo revision due to various complications ( 3). As our population continues to age, we will see the incidence of this procedure increase and around 100,000 THRs are already being performed annually with a year on year rise. The THR is one of the most common and successful procedures performed as a treatment for osteoarthritis ( 2). Total hip replacements (THR) have been performed in the UK from the 1960s and since then we have seen surgical techniques, the design of implants, and imaging modalities rapidly develop ( 1). Being aware of the imaging modalities that are available to orthopedic surgeons, and discussing these challenging cases with specialist radiologists will enable optimal management of THR complications. Ultrasound (US) has a limited role in the assessment of most THR complications but can be useful to identify peri-prosthetic fluid collections and the presence of soft tissue sinus tracts. However, due to the limited availability and increased costs when performing leukocyte-marrow scintigraphy, CT and SPECT-CT would be a more preferred option when suspecting prosthesis infection. Research confirms that leukocyte-marrow scintigraphy is the modality of choice for accurately diagnosing prosthetic joint infection and reassures us of its superiority over other nuclear medicine imaging. CT and MRI are accurate in identifying the diagnosis of most causes of THR complications except infection. Optimized pulse sequences and metal artifact reduction techniques have made MRI a useful tool in diagnosis of soft tissue abnormalities and is particularly useful in identifying adverse local tissue reactions in metal on metal implants. MRI has evolved to become an important diagnostic tool for the evaluation of THR in the post-operative period. SPECT imaging also has the advantage of showing the bone's metabolic activity and is less prone to metal artifact than Magnetic resonance imaging (MRI). Single photon emission computed tomography with CT (SPECT-CT) is an emerging modality which has shown to combine the sensitivity that bone scintigraphy offers with the high specificity of CT. CT is relatively low-cost, simple to perform and easily available making it an excellent tool to supplement radiographs when trying to evaluate a hip prosthesis. As for all investigations for bone and joints, a radiograph is the first imaging to be performed for any patient with a THR and can detect a majority of complications. This paper will aim to review the different complications and imaging appearance which help to evaluate each problem. Total hip replacements (THR) have been performed in the UK from the 1960s and since then we have seen surgical techniques, the design of implants, and imaging modalities rapidly develop. 2Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.1Department of Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, United Kingdom.Nida Mushtaq 1 *, Kendrick To 2, Chris Gooding 2 and Wasim Khan 2
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