These can occur from screws which are inserted to hold the acetabular cup in place. Penetration of the femoral bone by the prosthesis can occur with difficult revision hip surgery, particularly in patients with bone stock loss and osteoporosis.
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Paprosky has developed two systems for classification of acetabular (Table )  and femoral defects (Table ) , respectively. Acetabular and femoral defects must be separately assessed, although a combined assessment is needed at the time of surgery. Both classification systems allow for the prior choice of which prosthesis to use at the time of reimplantation, and which type of graft depending on whether or not the residual bone guarantees mechanical hold of the implant.
A specific radiological evaluation of hip joint infections does not exist to our knowledge. However, several authors have used different radiological systems that have been primarily developed for determining acetabular and femoral defects at the site of an aseptic loosening of hip arthroplasties also in the assessment of infected total hip replacements. The Paprosky- [, ], and the AAOS (American Academy of Orthopedic Surgeons) [-] classifications belong to the most widely used ones.
Lucent lines don't necessarily represent problem - may be present in well-fixed prosthesis (retrieval studies) - often due to remodelling O'Neil & Harris JBJS Am'84 1. Possible Bone-cement lucency - may be due to poor cementing technique - loosening if progressive 2. Probable Cement-implant radiolucent line >2mm wide - progressive 3. Definite 1.
Revision hip surgery is also performed because of dislocation of the components, subluxation or dislocation of the liner from the acetabular shell, deep infection, surrounding fracture of bone, prosthetic fracture and subsidence of the femoral stem.