Image Analysis Record Sheet

Image Analysis Record Sheet Case No.:______1.1 Dianosis for cementless stem: □ well fixed □ possible loosening(not sure) □ loosening 1.2 Evidences supporting “well fixed” stem: Please tick“√”in the “□” if spot welds are present, and record the corresponding zones Zone 1~7 Zone 8~14 □ spot weld 1.3 Evidences supporting “loosening” stem: Please tick“√”in the corresponding “□” if the following signs are present □ complete circumferiencial RLL ≤ 1.0 mm wide encircling prosthesis □ complete circumferiencial RLL > 1.0 mm wide encircling prosthesis 1.4 Evidences supporting “possible loosening (not sure)” stem: Please tick “√” in the “□” if the signs are present, and record the corresponding zones Zone 1~7 Zone 8~14 □ Regional RLL ≤ 1.0 mm wide □ Regional RLL > 1.0 mm wide □ Segmental bone defect □ Contained bone defect

2.1 Dianosis for cementless cup: □ well fixed □ possible loosening(not sure) □ loosening 2.2 Evidences supporting “well fixed” cup: Please tick“√” in the blanks if spot welds are present in the corresponding zones Zone 1 Zone 2 Zone 3 spot weld 2.3 Evidences supporting “loosening” cup: Please tick“√”in the corresponding “□” if the following signs are present: □ complete circumferiencial RLL ≤ 1.0 mm wide encircling prosthesis □ complete circumferiencial RLL > 1.0 mm wide encircling prosthesis 2.4 Evidences supporting “possible loosening (not sure)”: Please tick“√” in the blanks if the following signs are present in the corresponding zones Zone 1 Zone 2 Zone 3 Regional RLL ≤ 1.0 mm wide Regional RLL > 1.0 mm wide Segmental bone defect Contained bone defect

RLL = Radiolucent Line