Abstract

Objective: To evaluate the advantages of digital tomosynthesis over radiography in the assessment of total hip arthroplasty (THA) in clinical settings.

Patients and Methods: (1) In the prospective study, 90 THAs of 150 primary cemented THAs performed with bulk bone grafting for dysplastic hips were assessed postoperatively for up to 5 years. (2) In the retrospective study, radiography and digital tomosynthesis were performed on 832 consecutive hips that underwent THA and were referred for valuation of bone structure, bone reactions around prostheses, and remodeling of grafted bones. The tomosynthesis images were compared with anterior-posterior radiographs with regard to demarcation (radiolucent zone, RLZ).

Results: (1) In the radiographic assessment of 90 hips with acetabular bone graft reconstruction, bridging trabeculation, remodeling, and reorientation were observed at 4.6 ± 2.3, 9.0 ± 3.7, and 16.1 ± 5.8 postoperative months, respectively. In contrast, these bone reactions were observed on tomosynthesis at 9.8 ± 2.7, 17.4 ± 4.9, and 27.3 ± 6.7 months, respectively (p < 0.05). (2) In the evaluation of THAs in this study, digital tomosynthesis was found to provide better visualization of bone reactions structures around prostheses, and demarcations between prostheses and bones than radiography. In the evaluation of 804 cemented socket cases, the RLZ in zone 1 was identified in 118 cases on radiography and in 197 cases on tomosynthesis (p < 0.05).

Conclusions: In the evaluation of THA, digital tomosynthesis provided better visualization of bone reactions, structures around prostheses, and demarcations between cemented or cementless prostheses and bones than radiography.

Keywords: Digital tomosynthesis; Metal artifact reduction technology; Radiological assessment; Total hip arthroplasty