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Painful Infection at the Site of Hip Prosthesis: CT Imaging¹

¹ From the Departments of Radiology (C.C., M.P.S., P.T.) and Orthopaedics (P.M.), Hôpital Lapeyronie, 371 avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France; and the Department of Radiology, Hôpital Caremeau, Nimes, France (V.H., F.M.L.). Received June 4, 2001; revision requested July 2; revision received November 14; accepted January 7, 2002. Address correspondence to C.C. (e-mail: c-cyteval @chu-montpellier.fr).

PURPOSE: To prospectively determine the accuracy of computed tomography (CT) in the detection of painful infection at the site of hip prosthesis before surgery.

MATERIALS AND METHODS: Helical CT examinations of hip prostheses were prospectively performed before surgery after a standard clinical and radiologic examination of 65 patients. CT scans and conventional radiographs were reviewed for periprosthetic bone abnormalities, and CT scans were reviewed for periprosthetic soft-tissue abnormalities (joint distention, fluid-filled bursae, and fluid collection in muscles and perimuscular fat). Patients subsequently underwent revision arthroplasty within 1 month, and infection was diagnosed in 12 (19%) patients.

RESULTS: Infection was detected clinically in 25% of patients. Periprosthetic bone abnormalities did not allow differentiation of infection from complications not related to sepsis, except for periostitis, with 100% specificity but only 16% sensitivity. Soft-tissue findings were accurate for detection of infection, with 100% sensitivity and 87% specificity. Fluid collection in muscles and perimuscular fat had a 100% positive predictive value, and absence of joint distention had a 96% negative predictive value.

CONCLUSION: CT is accurate in the diagnosis of painful infection at the site of a hip prosthesis on the basis of soft-tissue findings, whereas periprosthetic bone abnormalities are not useful.

© RSNA, 2002

Index terms: Hip, CT, 44.12111, 44.12115 • Hip, infection, 44.20 • Hip, prostheses, 44.454

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