Periprosthetic osteolysis is a common cause of revision of total knee arthroplasties (TKAs), with plain anteroposterior and lateral (APL) radiographs being the most common method for screening. The aim of this study was to examine the utility of lesion detection and volume appreciation with APL, paired oblique radiographs, and computed tomography. Defects of different sizes were created in 3 cadaveric knees with a cementless TKA in situ and imaged with APL, oblique, and computed tomography modalities. The resultant images were then shown to 3 arthroplasty surgeons, and the absence or presence of lesions, volume size, and confidence in assessment were recorded. The results suggest that the current practice of APL is inferior for the assessment of periprosthetic osteolysis around TKA.