Lymphatic filling in arthrography following total hip replacement

The significance of lymphatic filling at hip arthrography on prosthetic hips is uncertain. Clearly if lymphatic opacification has a direct relationship to loosening, this could lead to increased surgical exploration. Ninety-one patients were studied to determine whether opacification of lymphatics during hip arthrography correlated with loosening of the prosthetic hip. Plain radiographs were evaluated and a total of 92 hip arthrograms were assessed retrospectively. Radiological evidence of prosthetic loosening at hip arthrography was present in 61 patients. Fifty-three patients subsequently had surgical exploration and 50 were confirmed to have loose and/or infected components. In only 18 of these patients had lymphatic filling been demonstrated at arthrography. No evidence of loosening was seen in 23 patients; however, lymphatic opacification occurred in 10 of these arthrograms. This study does not demonstrate any correlation between prosthetic loosening, either with or without infection, and filling of the nearby lymphatic vessels. This finding contradicts and earlier report in the literature.