Clinical Imaging and Diagnosis 

Topic two explores the basics of clinical examination, the principles of radiology with and without implants in situ and why imaging is so important for an orthopaedic surgeon.

Clinical examinations

Examining the hip and knee is an important skill for people in the orthopaedic world, for physiotherapists, nurses and doctors alike. Additionally, understanding the clinical exam of each joint can help to highlight the common pathology we are examining for. Look at these videos for a guide.

Hip examination

Radiology

Different imaging techniques are useful for imaging different structures. The lecture series will discuss the importance of imaging in both diagnosis, planning and assessing surgical outcome.

  • Radiographs - Simple plane film radiographs are the first screening tool in orthopaedics to assess the calcified structures

  • Ultrasound - Useful for the rapid assessment of soft tissues

  • MARS MRI - Metal artefact reduction sequencing MRI is required when assessing the anatomy around a joint with metal work present. The metal can disrupt the MRI signal, obscuring the surrounding anatomy.

  • CT - Useful for understanding calcified structures in 3D. Modern reconstruction can be used to model the patients own anatomy for surgical planning.

  • EOS - A novel imaging system that takes whole body radiographs with the patient in a functional position (both sitting and standing) in two different planes. This system is invaluable for assessing the patients functional leg length after lower limb orthopaedic procedures.

EXAMPLES:

This radiograph demonstrates osteolysis around the right cup of the  Birmingham hip replacement. Osteolysis is the resorption of bone due to an inflammatory response.

MARS MRI demonstrating a large extrapelvic pseudotumour. This is a collection of inflammatory material caused by an adverse reaction to metal debris due corrosion between the cobalt chromium head and the titanium stem.

Knee examination

This is a single slice from a CT scan of a patient with a complex acetabular defect. This scan was used to produce a 3D model and design a custom implant for the patient.

OS imaging is used to assess the length of a patients leg in a functional position. This is extremely important before and after any lower limb joint replacement as a change in the length of the leg can cause a functional impairment for the patient.