Clinical Orthopaedics and Related Research: March 2006 - Volume 444 - Issue - p 176-183 doi: 10.1097/01.blo.0000201149.14078.50

Radiographic Signs of Osseointegration in Porous-coated Acetabular Components

Moore, Milan, S*; McAuley, James, P†; Young, Anthony, M‡; Engh, Charles, A, Sr.†

There currently is no direct method to radiographically determine osseointegration of an uncemented, porous-coated acetabular component. We defined five radiographic signs for detecting acetabular osseointegration: (1) absence of radiolucent lines; (2) presence of a superolateral buttress; (3) medial stress-shielding; (4) radial trabeculae; and (5) an inferomedial buttress. We assessed their ability to predict acetabular osseointegration by reviewing the postprimary and prerevision radiographs from a series of 119 total hip arthroplasties that had revision surgery. Each sign had a high positive predictive value for the presence of bone ingrowth (range, 92.2-96.3%). The absence of radiolucent lines, presence of superolateral buttresses, and presence of medial stress-shielding were the most sensitive signs for indicating bone ingrowth. Ninety-seven percent of the cups with three to five signs were bone ingrown, whereas 83% of the cups with one or no signs were unstable. When three or more signs were present, the positive predictive value of the radio-graphic test was 96.9%, the sensitivity was 89.6%, and the specificity was 76.9%. The five signs of acetabular osseointegration reliably predicted osseointegration, especially when used in combination. They can be used as a tool for radio-graphically assessing the status of patients with porous-coated uncemented cups.


Level of Evidence: Diagnostic study, Level III (Study of nonconsecutive patients; without consistently applied reference “gold” standard). See the Guidelines for Authors for a complete description of levels of evidence.

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