Diagnostic imaging strategy
1. Standard radiographic imaging
When evaluating any periprosthetic fracture around a previous total hip arthroplasty, a complete imaging evaluation of both the femur and the acetabulum includes:
- Antero-posterior (AP) pelvis
- Cross-table lateral hip
- Judet views (iliac and obturator oblique)
- Pelvic inlet and outlet
- Full-length AP and lateral femur
- Full-length AP and lateral of the contralateral femur
- Preinjury radiographs if available
For further detail on these imaging techniques and the interpretation of the imaging please refer to the dedicated section of the acetabulum: radiology of the intact acetabulum.
2. CT imaging
Due to the complex anatomy, preoperative CT imaging is routine where available. The imaging protocol is similar to any acetabular/pelvis fracture. Metal subtraction technique may reduce the artifacts from existing implants.
Consider CT angiography for periprosthetic acetabular fractures. This can help delineate the vascular anatomy in relation to the bone and prosthesis.
