Document Overview

Document Title

Imaging After Total Hip Arthroplasty

Authoring Society

American College of Radiology

Document Publication Date

Nov 30, 2023

Page Last Reviewed/Updated

May 15, 2026

Document Type

Appropriate Use Criteria

Country of Publication

United States

Full Text Freely Available

Yes

Full Text Guideline

www.jacr.org/article/S1546-1440(23)00615-4/fulltext

Source Citation

Expert Panel on Musculoskeletal Imaging; Weissman BN, Palestro CJ, Fox MG, Bell AM, Blankenbaker DG, Frick MA, Jawetz ST, Kuo PH, Said N, Stensby JD, Subhas N, Tynus KM, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria® Imaging After Total Hip Arthroplasty. J Am Coll Radiol. 2023 Nov;20(11S):S413-S432. doi: 10.1016/j.jacr.2023.08.015. PMID: 38040462.

Document Scope, Criteria, and Use Cases

Document Objectives

This article reviews evidence for performing various imaging studies in patients with total hip prostheses. Routine follow-up is generally performed with radiography. Radiographs are also usually the initial imaging modality for patients with symptoms related to the prosthesis. Following acute injury with pain, noncontrast CT may add information to radiographic examination regarding the presence and location of a fracture, component stability, and bone stock. Image-guided joint aspiration, noncontrast MRI, and white blood cell scan and sulfur colloid scan of the hip, are usually appropriate studies for patients suspected of having periprosthetic infection. For evaluation of component loosening, wear, and/or osteolysis, noncontrast CT or MRI are usually appropriate studies. Noncontrast MRI is usually appropriate for identifying adverse reaction to metal debris related to metal-on-metal articulations. For assessing patients after hip arthroplasty, who have trochanteric pain and nondiagnostic radiographs, ultrasound, or MRI are usually appropriate studies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Scope

Assessment and Screening

Diseases/Conditions (MeSH)

D019644 - Arthroplasty, Replacement, Hip

D006622 - Hip Prosthesis

Keywords

ALTR (adverse local tissue reaction), appropriate use criteria, metal artifact reduction, total hip arthroplasty imaging, total hip prosthesis complications

Inclusion Criteria

Male, Female, Adult, Older Adult

Health Care Settings

Ambulatory, Radiology Services

Intended Users

Nurse, Nurse Practitioner, Physician, Physician Assistant, Radiology Technologist