(Fig 5-D.15) Periprosthetic Infection - Periprosthetic Lucency

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MSK MRI Jee Eun Lee

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📌 Periprosthetic Infection

✅ Diagnostic Workup

• The diagnostic workup for infection begins with two nonspecific blood markers of inflammation: erythrocyte sedimentation rate and C-reactive protein concentration. 

 

✅ Radiographic Findings

• Radiographic findings of infection can vary from completely normal to frank bone destruction mimicking loosening or particle disease. 
• Typical radiograph findings include soft tissue swelling, large joint effusion, and periosteal reaction in severe cases. 
• Periosteal new bone formation or adjacent soft tissue fluid collection are more specific but lack sensitivity. 
• Periosteal reaction due to infection needs to be differentiated from that related to healing, which may be difficult. 

 

📌 Periprosthetic Infection vs Aseptic Loosening

✅ Diagnostic Challenges

• Many patients with either infected TKA or aseptic loosening present with chronic indolent pain or loosening, making it challenging to distinguish between these conditions. 

• Radiographic findings in infection, such as periprosthetic lucency, osteolysis, and prosthesis migration, may be seen in aseptic loosening as well. 
• [Periprosthetic Infection] Periosteal new bone formation or adjacent soft tissue fluid collection are more specific but lack sensitivity. 

 

References

1. AJR 2014; 202:W76–W86
2. Semin Musculoskelet Radiol 2017;21:147–164
3. Semin Musculoskelet Radiol 2019;23:e20–e35.

 

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#PeriprostheticInfection, #RadiographicFindings, #DiagnosticWorkup, #InfectionMarkers, #TKAInfection, #AsepticLoosening, #ChronicPain, #Radiographs, #BoneDestruction, #JointEffusion