Digital imaging is not superior to film-screen imaging for the detection of periprosthetic osteolysis around total knee arthroplasties.

Our aim was to compare the assessment of periprosthetic osteolysis around total knee arthroplasties using digital images against film-screen images. Simulated osteolytic lesions were created around 3 cadaveric total knee arthroplasties images acquired using fluoroscopic-assisted radiography and Computed Tomography. Three surgeons reviewed the film-screen images (AP/Lateral, Oblique, and Computed Tomography (CAT)) and the same images digitally. Combinations of 2 or more images that included the AP/Lateral views had superior performance in both film-screen and digital imaging to AP/Lateral views alone, except for the digital AP/Lateral/OBL combination. Lesion detection and volume appreciation were superior for film versus digital assessment for most angles. The addition of obliques to assessment using digital imaging improved performance, but film-screen remained superior to digital imaging for assessment of periprosthetic osteolysis.