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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I had a knee replacement six months ago. Everything is going fine but suddenly my surgeon wants to take X-rays and order a CT scan. Is this really necessary?

Surgeons routinely follow patients to make sure they have a successful outcome. With joint replacements, there can be problems that develop that the patient is totally unaware of. Delayed diagnosis of complications like infection, osteolysis, or delamination of the implant can lead to failure of the implant. Osteolysis is the resorption of bone to the point that holes form where there has been bone loss. These holes can be tiny pinpoints but they can get much worse over time. Imaging studies such as X-rays, CT scans, and MRIs give the surgeon a better inside view of bone quality. It's the best way we have to identify and evaluate the degree of the problem. X-rays are the place to start but they are limited in what they can show. The surgeon will be able to see if there are any fractures in the bone around the implant (or even a fracture of the implant itself). CT scans and MRIs give a better estimation of the extent of osteolysis and damage caused by this problem. For patients who have small areas of osteolysis that don't apprear to be growing, treatment is careful monitoring. If the problem starts to get worse, efforts must be made to put a stop to the progression. Right now, there isn't a "best known" treatment to halt the progression of osteolysis. Medications such as antiinflammatories and bisphosphonates (prevent bone resorption) are the first thing to try. Studies are really needed to see if this approach is effective. With large bone lesions, the polyethylene liner is removed and replaced. Every effort is made to prevent bone loss from the osteolysis and during the revision surgery. X-rays, CT scans, and/or MRIs help give the surgeon additional information about the location, size, and extent of the osteolysis. Bone grafting may be necessary to fill in the holes and stimulate bone growth and repair. Your surgeon may have reason to believe there is something going on that must be further investigated. Or it may be possible your surgeon is a thorough, careful physician who is making sure all is indeed well. Don't hesitate to ask for his or her reasoning in ordering additional tests when and if you don't understand their necessity.


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