Preface xi

Laura W. Bancroft

Optimizing Techniques for Musculoskeletal Imaging of the Postoperative Patient 323

Carolyn M. Sofka

Knowledge of imaging principles and parameter modifications of advanced imagingtechniques—nuclear medicine, ultrasound, CT, and MR—aid musculoskeletal radiologistsin selecting the appropriate examination for clinical questions; tailoring imaging param-eters results in better image quality, thus more confident diagnoses. CT can evaluate forsubtle fractures often better than conventional radiographs. Adjusting the area of inter-est, increasing the peak kilovoltage (kVp), and viewing images with postprocessing soft-ware allow better CT image quality. Proper modification of MR imaging parametersalso provides useful information including visualizing the extent of osteolysis betterthan conventional radiographs. Fast spin echo imaging should be used, gradient echoavoided, and fast inversion recovery used instead of frequency-selective fat suppression.

Postoperative Imaging of the Shoulder 331

Kimberly A. Ruzek, Laura W. Bancroft, and Jeffrey J. Peterson

The management of the postoperative shoulder has improved, in part because of advancesin imaging techniques. As disability and pain may occur or persist after shoulder surgery,it is imperative that clinicians have a detailed anatomic delineation before further treat-ment. Variations in surgical techniques, surgical distortion of native anatomy, and metallicartifacts decrease the accuracy of postoperative imaging. Pitfalls may be avoided withknowledge of postoperative alterations of the rotator cuff, labrum, and capsule.

Postoperative Imaging of the Hip 343

Douglas P. Beall, Hal D. Martin, Justin Q. Ly, Scot E. Campbell, Suzanne Anderson,and Moritz Tannast

The number and type of operative procedures involving the hip continue to increase,placing a greater emphasis on characterizing patient postoperative condition accurately.Optimal postoperative imaging evaluation may involve multiple modalities, includingconventional radiography, radionuclide scintigraphy, and cross-sectional imaging. Many

vii

Contents

POSTOPERATIVE MUSCULOSKELETAL IMAGING

Volume 44 • Number 3 • May 2006

Contentsviii

of the surgical procedures involve the placement of metallic joint replacements or fixa-tion that can make the imaging evaluation of the postoperative anatomy challenging.Clinical examination of patients combined with the type of procedure performed directthe appropriate imaging evaluation; adequate clinical knowledge of these proceduresand how to optimally image them provide an opportunity to attain the most accurateevaluation possible.

Postoperative Imaging of the Knee 367

Matthew A. Frick, Mark S. Collins, and Mark C. Adkins

The knee is a frequently injured joint and, thus, a common focus of operative interven-tion. As operative techniques and imaging modalities evolve, radiologists must beaware of the expected postoperative appearance after knee surgeries that are performedcommonly and also must be comfortable recognizing complications encountered com-monly in the immediate and delayed postoperative period. Drawing on the largeamount of attention this subject has received of late in the radiologic and orthopedicliterature, this article reviews the knee surgeries performed most commonly and theexpected normal and most frequently encountered abnormal postoperative imagingfindings with an emphasis on MR imaging.

Postoperative Imaging of the Ankle and Foot 391

Diane Bergin and William B. Morrison

This article describes the relevant surgical detail and MR imaging appearance of commonoperations performed in the foot and ankle. To evaluate postsurgical patients critically, itis important to understand the primary clinical diagnosis, surgical treatment undergone,the interval since surgery, and patients’ current clinical symptoms. Radiography is themost common imaging modality for evaluation of the postoperative ankle and foot. MRimaging may be useful for evaluating the soft tissues and osseous structures in the post-surgical foot and ankle.

Imaging of the Postoperative Spine 407

Thomas H. Berquist

Spinal instrumentation techniques have expanded dramatically during the past severaldecades, but the search for the perfect operative approach and fixation system continues.Fixation devices are designed for the cervical, thoracic, lumbar, and sacral segmentsusing anterior, posterior, transverse, videoarthroscopic, and combined approaches. Inmost cases, bone grafting also is performed, because instrument failure occurs if solidbony fusion is not achieved. Radiologists must understand the operative and instrumen-tation options. Knowledge of expected results, appearance of graft material, and differentforms of instrumentation is critical for evaluating position of implants and potentialcomplications associated with operative approaches and spinal fixation devices.

Imaging of Joint Replacement Procedures 419

Thomas H. Berquist

Joint replacement procedures have improved dramatically during the past 30 years fueledby the changes in techniques for hips and knees. Joint replacements in other anatomicregions also have become more popular. It is essential to understand the importance of

Contents ix

pre- and postoperative imaging for evaluating patients. Preoperative images are used inconcert with clinical data to select the appropriate patients and components. Postoperativeimaging is critical for evaluating position and potential complications. Appropriate selec-tion of imaging modalities is essential to provide optimal, cost-effective patient care.

Postoperative Infection 439

Jeffrey J. Peterson

Infectious disease complicating surgery involving the musculoskeletal system is one ofthe most important causes of postoperative morbidity and mortality. Timely detectionand accurate localization of infectious processes have important clinical implicationsand are critical to appropriate patient management. Imaging studies can play an impor-tant role in the detection of infection and can help guide appropriate clinical manage-ment. The diagnosis of postoperative infection can be made by a variety of imagingmodalities. This article reviews the various methods and modalities available for thedetection of postoperative infection.

Bone Graft Materials and Synthetic Substitutes 451

Francesca D. Beaman, Laura W. Bancroft, Jeffrey J. Peterson, and Mark J. Kransdorf

Bone graft materials quickly are becoming a vital tool in reconstructive orthopedic sur-gery and demonstrate considerable variability in their imaging appearance. Functions ofbone graft materials include promoting osseous ingrowth and bone healing, providinga structural substrate for these processes, and serving as a vehicle for direct antibioticdelivery. The three primary types of bone graft materials are allografts, autografts, andsynthetic bone graft substitutes.

Soft Tissue Tumors: Post-Treatment Imaging 463

Mark J. Kransdorf and Mark D. Murphey

As the radiologic evaluation of soft tissue masses has changed dramatically with theadvent of MR imaging, the effect of MR imaging is even more striking in the assessmentof patients after treatment. In cases of local tumor recurrence, MR imaging has becomethe standard of care. Using a few basic principles, even small local recurrences can bedetected accurately, and recurrence can be distinguished from postoperative or post-treatment change. This review presents a fundamental approach to the evaluation ofpatients, following treatment for soft tissue tumors and highlighting MR imaging.

Index 473