Minireviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Feb 28, 2025; 17(2): 102373
Published online Feb 28, 2025. doi: 10.4329/wjr.v17.i2.102373
Imaging evaluation of periprosthetic loosening: A primer for the general radiologist
Sahil S Shet, Eid Kakish, Stephen Christopher Murphy, Ryan Roopnarinesingh, Stephen P Power, Michael M Maher, David J Ryan
Sahil S Shet, Eid Kakish, Michael M Maher, David J Ryan, Department of Radiology, School of Medicine, University College Cork, Cork T12 AK54, Ireland
Stephen Christopher Murphy, Ryan Roopnarinesingh, Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Cork T12 DC4A, Ireland
Stephen P Power, Michael M Maher, David J Ryan, Department of Radiology, Cork University Hospital, Cork T12 DC4A, Ireland
Author contributions: Shet SS, Kakish E, Ryan DJ, and Maher M designed the research study; Shet SS, Kakish E, Murphy SC, and Roopnarinesingh R performed the literature search; Power SP, Ryan DJ, and Maher MM conducted image analysis and provided relevant cases; Shet SS, Kakish E, and Murphy SC analysed the data and wrote the manuscript. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sahil S Shet, Department of Radiology, School of Medicine, University College Cork, College Road, Cork T12 AK54, Ireland. sshet@ucc.ie
Received: October 15, 2024
Revised: December 23, 2024
Accepted: January 18, 2025
Published online: February 28, 2025
Processing time: 133 Days and 18.5 Hours
Abstract

In response to an ageing global population, the primary hip and knee arthroplasty rate continues to increase. Although an effective treatment, up to 25% patients may require revision arthroplasty during their lifetime, commonly due to periprosthetic loosening. Revision procedures are associated with significantly increased healthcare costs; therefore, timely and accurate diagnostics are critical for clinicians and patients. Loosening, which may be septic or aseptic, remains a challenge and requires thorough clinical examination and multimodal imaging evaluation. Plain radiographs remain an essential diagnostic tool but advanced imaging modalities such as computed tomography, magnetic resonance imaging and nuclear medicine are playing an increasingly important role. This comprehensive review, through outlining the available radiological modalities, their respective strengths and weaknesses and the pertinent imaging findings, may help radiologists and orthopaedic surgeons make more informed decisions in the management of periprosthetic loosening.

Keywords: Periprosthetic loosening; Total hip replacement; Total knee replacement; Diagnostic radiology; Aseptic loosening

Core Tip: As the rate of joint arthroplasties continue to rise, so too does the rate of revision arthroplasty. One of the primary indications for revision surgery is periprosthetic loosening; however, diagnosis of this condition is challenging. In this review, we discuss some of the major breakthroughs and advances in imaging techniques that aim to address these challenges. Improvements in metal artefact reduction techniques in computed tomography and magnetic resonance imaging have markedly improved image quality and diagnosis. In addition, nuclear medicine imaging techniques such as single-photon emission computed tomography/computed tomography are proving to be an excellent aid in diagnosis.