DeLee and Charnley and Gruen zones

Last revised by Leonardo Lustosa on 1 May 2024

DeLee and Charnley and Gruen classified the radiolucent lines between the total hip arthroplasty and the bone seen on the AP and lateral views of the operated hip in three acetabular zones and seven femoral zones, respectively.

Loosening induces the formation of a fibrous or 'synovial-like' membrane that can appear as linear radiolucent lines on radiographs and CT.


DeLee and Charnley zones (acetabulum)
  • zone 1:  superior third (AP radiograph)

  • zone 2:  middle third (AP radiograph)

  • zone 3:  inferior third (AP radiograph)

  • zone 4: posterior third (lateral radiograph)

  • zone 5: middle third (lateral radiograph)

  • zone 6: anterior third (lateral radiograph)

Gruen zones (femur)
Zones 1-7 (anteroposterior radiograph)
  • zone 1: greater trochanter

  • zone 2: lateral mid stem

  • zone 3: lateral distal stem

  • zone 4: tip of the stem

  • zone 5: medial distal stem

  • zone 6: medial mid stem

  • zone 7: medial calcar

Zones 8-14 (lateral radiograph)
  • zone 8: anterior upper stem

  • zone 9: anterior mid stem

  • zone 10: anterior distal stem

  • zone 11: tip of the stem

  • zone 12: posterior distal stem

  • zone 13: posterior mid stem

  • zone 14: posterior upper stem

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