MRI post hip arthroplasty

F1 THAIWAT
AJ. PALANAN
MR Imaging of Hip
Arthroplasty Implants

Introduction
• Groin pain and thigh pain occur in 40% of post hip arthroplasty
• Primary hip arthroplasty procedure expected to increased from
208,600 in 2005 to 572,000 in 2030 in USA, more than 1 million
worldwide annually
• Between 2001 and 2015, there was an annual increase rate of 2.5% for
THA performed
• Incidence of complication 6.5-7.6%
1. Fritz, Jan, et al. "MR imaging of hip arthroplasty implants." Radiographics 34.4 (2014):E106-E132.
6. Awan, Omer, Lina Chen, and Charles S. Resnik. "Imaging evaluationof complications of hip arthroplasty: review of current concepts and
imaging findings." Canadian Association of Radiologists Journal 64.4 (2013):306-313.
7. Zagra, Luigi, and Enrico Gallazzi."Bearing surfaces in primary total hip arthroplasty." EFORT open reviews 3.5 (2018):217-224.

Type
• Hip arthroplasty
• Hemiarthroplasty
• Unipolar
• Bipolar
• Total arthroplasty
• Fixating technique
• Cemented stem fixation
• Cementless stem fixation
• Hybrid (cemented femoral stem and a cementless acetabular cup)
• Reverse hybrid (cementless femoral stem and a cemented acetabular cup)
7. Zagra, Luigi, and Enrico Gallazzi."Bearing surfaces in primary total hip arthroplasty." EFORT open reviews 3.5
(2018):217-224.
8. Vanrusselt,Jan, et al. "Postoperative radiograph of the hip arthroplasty: what the radiologist should
know." Insights into imaging 6.6 (2015): 591-600.

1. cemented unipolar hemiarthroplasty
2. cementless bipolar hemiarthroplasty
3. cementless resurfacing hemiarthroplasty
4. cementless total hip arthroplasty
5. cementless resurfacing total hip arthroplasty
6. hybrid cemented total hip arthroplasty
7. reverse hybrid cemented total hip arthroplasty
Type
1 2 3 4 5 6
7 8

1. cemented unipolar hemiarthroplasty
2. cementless bipolar hemiarthroplasty
3. cementless resurfacing hemiarthroplasty
5. cementless resurfacing total hip arthroplasty
6. hybrid cemented total hip arthroplasty
7. reverse hybrid cemented total hip arthroplasty
Type
1 2 3 4 5 6
7 8
8. Vanrusselt, Jan, et al. "Postoperative radiograph of the hip arthroplasty: what the radiologist should know." Insights into imaging 6.6 (2015): 591-600.
9. Roth, Trenton D., et al. "CT of the hip prosthesis: appearance of components, fixation, and complications." Radiographics32.4 (2012): 1089-1107.

Plain radiograph in post hip arthroplasty
Charnley-Delee
Gruen
A-B
C – tear drop
C-D
E-D
F
I-J

Normal or acceptable findings in CT
• Radiolucent area between cement mantle and
bone
• Thin (≤2- mm)
• New or changing
• In uncemented femoral stems
• Normal to have mild subsidence (>2 -10 mm)
• Small air bubbles
• Prosthesis alters the stresses placed on a bone
• Calcar resorption and stress shielding
• Normal for the diaphyseal cortex to thicken in the
region of load transfer.
• (black arrow) bone in-growth
and “spot welding” of the
uncemented femoral stem.
• (white arrows) stress shielding,
which is responsible for the
relative hypoattenuation and
overall decrease in bone mass
in these regions.
femoral stem with a few air
bubbles in the cement
mantle (arrows), which
represent a normal finding
2. Hargunani, Rikin, et al. "Imaging of the painful hip arthroplasty." Canadian Association of Radiologists
Journal 67.4 (2016):345-355.
9. Roth, Trenton D., et al. "CT of the hip prosthesis: appearance of components, fixation,and
complications." Radiographics32.4(2012):1089-1107

Imaging Technique
• Arthroplasty implants cause a change in the
• local magnetic field
• locally altered precessional frequencies and
accelerated dephasing of proton
• These effects including
• spatial misregistration
• signal voids
• inhomogeneous fat suppression
• influenced by the composition and type of metal or
alloy used in implant construction and are roughly
proportional to field strength between 1.5T and 3T

Imaging Technique
5. Casado,O. S. C. A. R. "MRI of hip arthroplasty." ESSR 2014 Annual Scientific Meeting, 2014.

Imaging Technique

Imaging Technique
Increased amplitude gradient
Decreased artifact
Wide receiver bandwidth
and thin section

Wide bandwidth and smaller voxel size
Decrease in the signal-to-noise ratio
Imaging Technique

• Metal artifact reduction technique
• Section encoding for metal artifact correction technique (SEMAC: Siemens)
• Multiacquisition variable-resonance image combination technique (MAVRIC: GE)
• substantially reduce metal-related artifacts and drastically improve
depiction of the synovium-implant and bone-implant interfaces
• based on three-dimensional SE pulse sequences but use alternative
frequency- and phase-encoding schemes for correction of in-plane
and through-plane distortion artifacts
Metal artifact reduction technique

Imaging Technique
• Intermediate-weighted fast SE pulse
sequences with high spatial resolution
 periprosthetic bone and soft tissues.
• T2 poor signal-to-noise ratios
• low-signal-intensity metallic deposits
well depicted with intermediate-
weighted  heavilyT2-weighted MR
images without fat suppression are not
required.
• T1 poor fluid-to-synovium contrast ratio
• STIR high sensitivity for the detection of
fluid and bone marrow edema
• solid adverse local tissue reactions may not
be depicted

Figure 1. Insensitivity of STIR
images for the depiction of solid
synovial soft-tissue deposits in a
66-year-old man with a metal-
on-metal hip arthroplasty
implant and an adverse local
tissue reaction. (a) Coronal
intermediate-weighted fast SE
MR image (4002/31 [repetition
time msec/echo time msec])
shows a solid adverse local
tissue reaction (arrow) near the
greater trochanteric bursa. (b)
Corresponding coronal STIR
MAVRIC MR image (4253/37)
shows the reaction (arrow) as
inconspicuous
Imaging Technique

Post hip arthroplasty complication
• Periprosthetic fractures and stress reaction
• Aseptic loosening
• Joint instability and Hardware failure
• Hematoma
• Synovitis
• Particle disease
• Adverse local tissue reactions
• Metallosis
• Infection
• Tendinopathy and tendon tears
• Heterotopic ossification

Periprosthetic Fracture and Stress
Reaction
• Incidence 18%
• Most occur around the
femoral component
• Risk factor
• Component varus position
• Previously treated fractures
• Micromotion caused by
periprosthetic bone
resorption
• Image finding
• localized signal hyperintensity of the marrow cavity
and endosteum
• thickening and hyperintensity of the cortex without
the presence of a fracture line
• periosteal thickening and hyperintensity
• adjacent soft-tissue edema
• linear hypointense signal alteration of the cortex
distinguishes a periprosthetic fracture from a stress
reaction
• Femoral marrow cavity preparation cause periprosthetic
signal hyperintensity of the marrow cavity, a finding that
may persist for months and therefore should be
differentiated from a stress reaction.

Reaction
Figure 2. Periprosthetic stress
reaction of the femur in a 63-
year-old man.
(a) Coronal inversion-recovery
of a metal-on-metal hip
arthroplasty system shows a
bone marrow edema
pattern, periosteal new bone
formation, and adjacent
soft-tissue edema (arrow)
along the medial margin of
the proximal portion of the
femur. No fracture line is
depicted.
(b) (b) Axial intermediate-
weighted fast SE MR image
(4100/22) shows cortical
hypointensity and periosteal
new bone formation (arrow).

Reaction
Periprosthetic fracture of the
femur in a 78-year-old woman.
Coronal inversion-recovery
MAVRIC MR image (4283/43) of a
metal-on-metal hip arthroplasty
system shows a fracture line
(arrow) involving the
posterolateral subtrochanteric
region, with a bone marrow
edema pattern and surrounding
soft-tissue edema, findings that
indicate acuity.
9. Roth, Trenton D., et al. "CT of the hip prosthesis: appearance of components, fixation,and complications." Radiographics32.4(2012):1089-1107.

Aseptic loosening
• Plain radiograph
• Cemented arthroplasty
• < 2 mm lucency at the bone-cement interface indicates the
formation of a fibrous membrane (representing the
lucency), outlined by a thin, sclerotic demarcation line.This
is thought to represent a stable fibrous reaction to cement.
• Cementless arthroplasty
• < 2 mm lucency also outlined by a thin sclerotic line, along a
polished segment where no bony ingrowth is expected,
indicates fibrous bony ingrowth and is thought to provide
sufficient stability
• Periprosthetic lucencies wider than 2 mm and/or
progressive lucencies are signs of abnormality
(Sensitivity 95% and specificity 100% for loosening).
2. Hargunani, Rikin, et al. "Imaging of the painful hip arthroplasty." Canadian Association of Radiologists
Journal 67.4 (2016):345-355.
know." Insights into imaging 6.6 (2015):591-600.

Septic loosening VS Aseptic loosening
Presence of a femoral periosteal reaction Rapid progressive disease
1 mo 3 mo 4 mo 5 mo

Aseptic loosening in CT
• Possible or probable
• Osteolysis, periprosthetic radiolucent area, endosteal
scalloping (a and b)
• Pedestral formation (bone sclerosis medullary canal just
distal to prosthetic tip (C)
• Bead shedding (punctate pieces of metal around an in-
growth component (D)
• Hardware or cement fractures
• Definite
• Excessive component movement
• (a) an acetabular cup that has tilted or migrated
• (b) a femoral stem that has rotated, migrated, toggled
(“windshield wiper” effect), or excessively subsided
C
D

Osseous integration and aseptic loosening
• Complete osseous integration : appears as direct contact between a
sharply demarcated implant and the surrounding trabecular bone
without separation
• Fibrous membrane formation : assumed from the presence of a smooth
intermediate- to high-signal-intensity layer that is interposed between
the host bone and the implant or cement with thickness 1-2 mm.
• Bone resorption : intermediate- to high-signal-intensity layer that is
interposed between the host bone and the implant or cement more than
a 2-mm thickness and irregularity indicating bone resorption
• Implant loosening : circumferential osseous resorption, especially with
additional signs such as implant displacement, rotation, or subsidence.
Serial MR imaging may be required to prove or disprove suspected
loosening.

Complete osseous integration
Complete osseous integration :
appears as direct contact
between a sharply demarcated
implant and the surrounding
trabecular bone without
separation

Fibrous membrane formation
Indicated by a
- thin layer of increased signal intensity (white
arrow) at the implant-bone interface,
- which is surrounded by a thin layer of
decreased signal intensity (black arrow).
Fibrousmembrane formation : assumed from the
presenceof a smooth intermediate-to high-
signal-intensitylayer that is interposed between
the host bone andthe implant or cement with
thickness1-2mm.

Bone resorption Implant loosening
circumferential bone resorption
Bone resorption : intermediate-
to high-signal-intensity layer
that is interposed between the
host bone and the implant or
cement more than a 2-mm
thickness and irregularity
indicating bone resorption
Implant loosening :
circumferential osseous
resorption, especially with
additional signs such as implant
displacement, rotation, or
subsidence.Serial MR imaging
may be requiredto prove or
disprove suspected loosening.

Instability and Dislocation
• Common reasons for revision hip
arthroplasty
• Risk factor
• Component malposition
• Imbalance of tissue tension
• Implant design
• Surgical approach
• Small femoral head
• Failure of the abductor mechanism
• Extent of surgical soft-tissue dissection during
implant placement may represent the most
important factor
complications." Radiographics32.4(2012):1089-1107.
• Dislodged polyethylene
liner (arrow) situated
between the left gluteus
maximus and gluteus
medius muscles

(7a) Initial CT image shows a ceramic head and
ceramic cup liner, with a normal fit.
(7b) CT image obtained 2 years later shows a
new gap (arrow) between the head and cup
liner resulting from wear.
(8a) wear of the polyethylene liner and superior
subluxation of the ceramic femoral head.
(8b) metal backing of the cup has also failed
and broken into two pieces, with further
superior migration of the head.

3. Potter, Hollis G., et al. "Magnetic resonance imaging after total hip arthroplasty: evaluationof periprosthetic soft tissue." JBJS86.9 (2004):1947-1954.
Cement mantle fracture
Cement in MRI show low signal
intensity close to cortex
Femoral stem fracture
- loose acetabular cup, including
cup tilt and migration
- screw fracture (arrow)
- bead shedding (circles)

• Posterior joint stability
• Key structure
• Posterior joint capsule
• Short external rotator muscles
(gluteus maximus, piriformis,
obturator internus, superior and
inferior gemelli, and quadratus
femoris)
• Intact posterior capsule (A)
• Capsular dehiscence .
• Muscle atrophy

• Anterior joint instability
• Acetabular cup anteversion
• The “safe zone” for acetabular anteversion is
20º±10º.
• Anterior joint capsule
• Additional findings after dislocation events
include component fractures, displacement
of the acetabular liner and unsuspected
persistent joint dislocation.
12. Cyteval, Catherine, et al. "Iliopsoas impingement on the acetabularcomponent: radiologicand computed tomography findings of a rare hip prosthesis
complicationin eight cases." Journal of computer assisted tomography 27.2 (2003):183-188.
• (black arrow) Hypertrophic scarring of the
anterior and posterior (white arrow) capsule,
which can occur in the setting of instability.
• (dotted line) excessive acetabular anteversion,
which measured 48º, a finding that represents a
risk factor for anterior instability.
• (arrowhead) fibrous membrane formation is
depicted along the posterior acetabular wall.

Hematoma
• Hematoma formation 1.7% of patients after total hip
arthroplasty
• Most postoperative hematomas occur in the first 2
weeks after surgery, whereas recurrent periprosthetic
hemarthrosis is rare.
• Typical MR imaging findings are a complex collection
causing capsular distention and, occasionally, a soft-
tissue mass.
• In recurrent hemarthrosis, MR imaging shows
thickening of the synovium, with hemorrhagic debris of
mixed signal intensity in the joint capsule or
trochanteric bursa.
• MR angiography may demonstrate the source vessel
and can help guide endovascular treatment or
arthroscopic cautery.
• (*) intracapsular hematoma
• (white arrow) disruption of the posterior capsule
• (arrowhead) retraction of the obturator internus tendon
• (black arrow) the hematoma extends into the
trochanteric bursa

Synovitis
6. Awan, Omer, Lina Chen, and Charles S. Resnik. "Imaging evaluationof complications of hip arthroplasty: review of current concepts
and imaging findings." Canadian Association of Radiologists Journal 64.4 (2013):306-313.
(a) Coronal intermediate-weighted
fast SE MR image (4002/31
[repetition time msec/echo time
msec]) shows a solid adverse local
tissue reaction (arrow) near the
greater trochanteric bursa.
(b) Corresponding coronal STIR
shows the reaction (arrow) as
inconspicuou
• Non-specific synovitis
• Wear-induced synovitis (Particle
disease)
• Adverse local soft tissue reactions and
pseudotumors
• Hypersensitivity-linked reaction (low wear)
• Metallosis (high-wear)
• Aseptic lymphocytic vasculitis associated
lesion (ALVAL)

Definition
• Wear
• The surface damage with progressive loss of material (debris)due to friction between moving
surfaces.
• Debris
• Particles of different material and size shed from the surface of the various parts of the implant due
to wear.
• Fretting
• Relative low amplitude movement (oscillationand sliding) between two mechanically joined parts,
under load conditions (between 1 μm and 100 μm). All modular junctions are susceptible to the
loadingof the body. It provokes wear (debris) and corrosion.
• Corrosion
• Surface degradationdue to electrochemical interactions producing metallicions and salts which
applies only to metals. Different distinct forms of corrosionhave been described (galvanic,fretting,
crevice, stress, etc).20
• Osteolysis
• Bone resorption due to biologicalresponse to debris including osteoclast activationthat can
compromise the bone stock around the implant and lead to loosening of the prosthesis in the
advanced phase.
7. Zagra,Luigi,and Enrico Gallazzi."Bearingsurfacesin primary total hip arthroplasty."EFORT open reviews3.5 (2018): 217-224.
10. Holzwarth,Uwe,and G. I. U. L. I. O. Cotogno. "Totalhip arthroplasty."Brussels: EuropeanCommission (2012).
11. Xia, Zhidao, et al. "Nano-analysesof wearparticlesfrom metal-on-metalandnon-metal-on-metaldualmodular neck hip arthroplasty."Nanomedicine:Nanotechnology,BiologyandMedicine 13.3 (2017): 1205-1217.

1. Fritz, Jan, et al. "MR imaging of hip
arthroplasty
implants." Radiographics 34.4 (2014):
E106-E132.
Synovitis

Synovitis
Intact pseudocapsule and synovium
Nonspecific postoperative effusion without conspicuous
synovitis

Synovitis
Polyethylene wear-induced synovitis
• MR imaging sensitivity of 95%,
compared with 75% for CT and 52%
for radiographs
• Imaging typically manifest as expansion
of the hip pseudocapsule by a thick and
particulate-appearing synovitis of low to
intermediate signal intensity that is often
similar in intensity to skeletal muscle,
with variable amounts of interspersed
fluid
• Pseudocapsular distension
• Pseudotumor
• Bulky osteolysis
• (arrowhead) dehiscence of the posterior pseudocapsule
• (arrow) particulate synovitis of low to intermediate signal intensity, which is similar to the
intensity of skeletal muscle
• (dark arrows) synovitis and debris tracking into the greater trochanteric bursa

Synovitis
for radiographs
fluid
• Pseudotumor
• (Arrow) intermediate- to low-signal-intensity solid-appearing debris

Synovitis
for radiographs
fluid
• Pseudotumor
• (white arrow) synovitis with expansion of the
pseudocapsule
• (*) high-signal-intensity fluid
• (black arrow) intermediate-signal-intensity debris, as well
as osteolysis
(*) periacetabular osteolysis

Synovitis
Bulky osteolysis

Adverse Local Tissue Reaction
• Reactions to arthroplasty-related
metal products, including
• metallosis caused by metal debris,
• reactive tissue inflammation caused by
metal ions and corrosion products,
• or combinations thereof
• The cellular inflammatory response
in the periprosthetic soft tissues
often resembles delayed or type IV
hypersensitivity-induced
inflammation
• Synonym : pseudotumor and adverse
reactions to metal debris
• MR imaging plays a key role in the diagnosis and
grading of adverse local tissue
• The histologic appearance of an adverse local tissue
reaction caused by metal products that has features of
hypersensitivity has been described as the aseptic
lymphocytic vasculitis–associated lesion (ALVAL)
• An MR imaging predictive model
• the presence of adverse local tissue reaction
identified maximal synovial thickness (>7 mm),
followed by a mixed solid-cystic synovial pattern,
as the best predictors for the diagnosis of a
moderate or severe adverse local tissue reaction
(ALVAL grade > 5)
• whereas pseudocapsular dehiscence, a mixed
pattern of synovitis, and decompression of
synovitis into the adjacent soft tissues were the
strongest predictors for intraoperative tissue
damage

• Metallosis typically occurs with high rates of implant wear and is
often associated with a lowALVAL grade.
• Metallosis is caused by the shedding of larger metallic debris (distinct
from metal ions in solution and corrosion products), findings similar in
appearance to polyethylene wear– induced synovitis and osteolysis.
• MR imaging findings of adverse local tissue reaction and
histologically diagnosed ALVAL range from expansion of the
pseudocapsule with homogeneous high-signal-intensity fluid
(Pseudocyst) and a relatively thin synovial wall lining to various
amounts of solid synovial proliferations and debris resembling
pseudotumors.
• Synovitis with low-signal-intensity debris that often displays features
of magnetic susceptibility and erosion into adjacent bone
• Additional findings that may be depicted are perisynovial edema and
local lymphadenopathy, which may overlap with the features of
infection.

• (*) decompression of fluid and synovitis into the
• (white arrow) greater trochanteric and iliopsoas
bursae and
• (black arrow) extensive adjacent soft-tissue
necrosis.
• (arrowhead) encasement of the thickened and
laterallydisplaced femoral nerve
• (*) solid synovitis
• (white arrow) disruption of the posterior capsule and incomplete encasement of the
sciatic nerve, which demonstrates thickened and hyperintense fascicles when
compared with the unaffected segment below(black arrow in b).
• (arrowhead ) tissue necrosis at the interface with the gluteus maximus muscle

49-year-old man who presented for follow-up
imaging 41 months after metal-on-metal total hip
arthroplasty. Images show case of synovitis classified
as “Other.”
• A, Coronal fast spin-echo image shows synovitis
as fluid signal intensity outlined by thickened
irregular pseudocapsule (arrows).
• B, Photomicrographof corresponding histologic
specimen shows thickened synovium (top) with
fibrinous exudate superficially (arrow), necrotic
and infarcted zone (one asterisk), and deep zone
with inflammatory cell infiltrate (two asterisks).
Final diagnosis was aseptic lymphocytic
vasculitis-associated lesions (score 9).
4. Hayter, Catherine L., et al. "MRI findings in painful metal-on-metal hip arthroplasty." American Journal of
Roentgenology199.4 (2012):884-893.

Metallosis
• Synovitis with low-signal-intensity debris
that often displays features of magnetic
susceptibility and erosion into adjacent
bone

Infection
• MR imaging features of infection
• synovitis and joint effusion
• edema and enhancement of the synovium, extracapsular tissue, and bone
• extracapsular collections and sinus tracts to the skin surface
• bone destruction
• reactive lymphadenopathy
• lamellation (layering) of a thickened hyperintense synovium is suggestive of an
infected hip arthroplasty implant
• additional findings of extracapsular soft-tissue edema, local
lymphadenopathy, and extracapsular collections increase the positive
predictive value
• Although features of osteomyelitis and bone destruction indicate aggressive
or long-standing infections, their absence does not exclude infection.
• Sarcoidlike granulomatous reactions to wear products , the coexistence of an
adverse local tissue reaction and infection, and underlying rheumatoid
disorders complicate the MR imaging patterns of infection.
• Image-guided joint aspiration is ultimately required to prove the presence of
an infection. • (arrows) layering (lamellation), and
hyperintensity of the synovium
• (* in ) expansion of the posterior capsule
• At microbiologic analysis of fluid obtained
with joint aspiration, Peptostreptococcus
was isolated.

Tendon Complications
Iliopsoas screw impingement
• (White arrow) : iliopsoas tendon impingement
• (black arrow) : tendon tear with retraction

Tendon Complications
(a) Image shows chronic stripping and retraction of the gluteus minimus tendon (arrow) with atrophy of
the gluteus minimus muscle bulk (*).
(b) Image shows chronic high-gradepartial stripping of the gluteus medius tendons (arrow) near the
insertion.

Heterotopic Ossification
• Heterotopic bone formation occurs in 50%–
60% of patients after hip arthroplasty
• Risk factors include male gender, a history of
heterotopic ossification, osteoarthritis with
preexisting heterotopic bone, ankylosing
spondylitis, and diffuse idiopathic skeletal
hyperostosis
• During the maturation phase, elevated body
temperature, joint pain, swelling, and warmth
may develop, which may be difficult to
differentiate clinically from infection

• At MR imaging
• Immature heterotopic ossification manifests
as a heterogeneous irregular process with
mass effect on the surrounding tissue
• Correlation with radiographic or CT findings is
helpful for the detection of areas of early
mineralization and is suggestive of the diagnosis,
but early heterotopic ossification may be
radiographically occult.
• Mature heterotopic ossification resembles
the MR imaging appearance of cancellous
bone, with a thin hypointense cortex and
characteristic fatty marrow deposits that are
suppressed on STIR MR images.

Brooker classification
(A) Class 1 is described
as islands of bone within the
soft tissues about the hip
(B) Class 2 includes bone spurs
originating from the pelvis or
proximal end of the femur,
leaving at least 1 cm between
opposing bone surfaces;
(C) Class 3 consists of bone
spurs originating from the pelvis
or proximal end of the femur,
reducing the space between
opposing bone surfaces to less
than 1 cm
(D) Class 4
shows apparent bone ankylosis
of the hip. Reproduced with
permission from Kate Sweeney.
13. Hug, Kevin T., Timothy B. Alton, and Albert O. Gee. "In brief: classificationsin brief: Brooker classification
of heterotopic ossificationafter total hip arthroplasty." (2015): 2154-2157.

• Ankylosing heterotopic ossification between
periacetabular bone and femur.
• Heterotopic ossification is seen in the
posterior aspect of the proximal femur (blue
arrows) which extends in continuity through
the level of the joint up to the periacetabular
bone (yellow arrows).
• Secondary impingement on the sciatic nerve
is also identified with mild fading of the nerve
fascicles at this point (circle and red arrow).

Reference
1. Fritz, Jan, et al. "MR imagingof hip arthroplastyimplants."Radiographics 34.4(2014):E106-E132.
2. Hargunani,Rikin, et al. "Imaging of the painful hip arthroplasty."Canadian Associationof RadiologistsJournal 67.4 (2016): 345-355.
3. Potter, Hollis G., et al. "Magnetic resonance imaging after total hip arthroplasty: evaluationof periprosthetic soft tissue."JBJS86.9 (2004):1947-1954.
4. Hayter,Catherine L., et al. "MRI findings in painfulmetal-on-metalhip arthroplasty." American Journal of Roentgenology199.4(2012): 884-893.
5. Casado,O. S. C. A. R. "MRI of hip arthroplasty."ESSR 2014 AnnualScientific Meeting,2014.
6. Awan, Omer, Lina Chen, and Charles S. Resnik. "Imaging evaluationof complications of hip arthroplasty:review of current concepts and imaging findings." CanadianAssociationof
RadiologistsJournal 64.4 (2013):306-313.
7. Zagra,Luigi, and Enrico Gallazzi."Bearing surfacesin primary total hip arthroplasty." EFORT open reviews 3.5 (2018):217-224.
8. Vanrusselt,Jan, et al. "Postoperative radiograph of the hip arthroplasty: what the radiologist should know." Insights into imaging 6.6 (2015): 591-600.
9. Roth, Trenton D., et al. "CT of the hip prosthesis: appearanceof components, fixation, and complications." Radiographics32.4(2012): 1089-1107.
10. Holzwarth, Uwe, and G. I. U. L. I. O. Cotogno. "Total hip arthroplasty."Brussels:European Commission(2012).
11. Xia, Zhidao, et al. "Nano-analysesof wear particlesfrom metal-on-metaland non-metal-on-metaldualmodular neck hip arthroplasty."Nanomedicine:Nanotechnology,Biologyand
Medicine13.3 (2017):1205-1217.
12. Cyteval, Catherine,et al. "Iliopsoas impingementon the acetabularcomponent: radiologic and computed tomography findingsof a rare hip prosthesis complication in eight
cases." Journal of computer assisted tomography 27.2 (2003):183-188.
13. Hug, Kevin T., Timothy B. Alton, and Albert O. Gee. "In brief: classificationsin brief: Brooker classification of heterotopic ossification after total hip arthroplasty."(2015): 2154-2157.

MRI post hip arthroplasty

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