Postgrad Med J doi:10.1136/pgmj.2009.095620
  • Review

How to read a postoperative total hip replacement radiograph

  1. Divya Prakash
  1. Department of Trauma and Orthopaedics, Sandwell General Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Lyndon, West Bromwich B71 4HJ, UK
  1. Correspondence to T McBride, Royal Orthopaedic Hospital, 10 Yarn Lane, Dickens Heath, Solihull B90 1TU, UK; tjm607{at}
  • Received 13 December 2009
  • Accepted 11 September 2010
  • Published Online First 7 November 2010


In 2006 over 55 000 primary total hip replacements were implanted in the UK. A crucial aspect of follow-up for these patients is the assessment of the postoperative radiograph. Information gained from the initial radiograph includes assessment of the quality of implantation and hence the likelihood of long term success. Follow-up radiographs can be assessed for signs of component failure. Orthopaedic surgeons, radiologists, junior surgical trainees, general medical practitioners, and advanced nurse/extended scope practitioners may all be required to interpret these radiographs during clinical practice. The authors feel that certainly during orthopaedic surgical training, not enough time is allocated to formal training on the systematic assessment of such radiographs. This review aims to provide the reader with a systematic approach to analysing the initial postoperative total hip arthroplasty radiograph, and subsequent follow-up films. Basics of patient positioning for obtaining radiographs, types of prosthesis encountered, and terminology used are covered. Assessment of initial radiographs focuses on assessing leg length, acetabular and femoral positioning, and cement mantle adequacy. Follow-up radiographs are assessed for signs of component failure. A review of the literature provides evidence for the assessment and importance of adequacy of component positioning, and good cementing technique. Normal and abnormal follow-up radiographic features are outlined to allow assessment of loosening or impending failure of a prosthesis.


  • Competing interests None to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of PMJ.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Navigate This Article