Diagnostic Performance of MRI for Component Loosening in Total Knee                     Arthroplasty Compared with Radiography

Endo, Yoshimi; Burge, Alissa J.; Koff, Matthew F.; Lin, Bin; Westrich, Geoffrey H.; Boettner, Friedrich; Chiu, Yu-Fen; Potter, Hollis G.

doi:10.1148/radiol.204458

Cited by 15 publications

(18 citation statements)

References 25 publications

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“…Four of the six patients with radiolucent lines in the current study had fibrous membranes detected, with the other two having all normal interfaces on MRI. Endo et al observed similar performance between radiography and MRI for diagnosing loosening in tibial components 22 . The radiographic and MRI findings are consistent here as well, with both suggesting that minor interference at the component–bone interface can still be observed in well‐fixed cementless implants.…”

Section: Discussionsupporting

confidence: 85%

“…At 6 months 4 of 40 tibial quadrants were fibrous, a ratio similar to another MRI study of a posterior‐stabilized version of the same cementless implant 23 . The presence of fibrous membranes results in the stimulation of osteoclasts that can lead to bone resorption and osteolysis, and indicates limited osseous integration has been achieved 21,22,34,35 . Again, no signs of osteolysis were present in this study, and most patients had their fibrous membranes resolved by 6 months.…”

Section: Discussionsupporting

confidence: 81%

“…The findings from MRI support the RSA measurements indicating that strong fixation is achieved. A study diagnosing TKA component loosening using MRI by Endo et al revealed that loosening is associated with fluid interfaces, osteolysis, complete absence of normal (trabecular bone signal flush with the metal or cement) interfaces, and poor (<33%) osseous integration 22 . None of the 10 tibial baseplates in this study met any of those criteria, as there were only normal or fibrous interfaces present and no patient had more than two quadrants classified as fibrous at any given time point.…”

Section: Discussionmentioning

confidence: 99%

“…The inter‐reader reproducibility of MRI has previously been shown to be substantial‐to‐excellent for interface characterization (Gwet agreement coefficient, 0.75–0.89) and for degree of osseous integration (Gwet agreement coefficient, 0.67–0.96). There is near‐perfect reproducibility for characterizing each component as loose at MRI (Gwet agreement coefficient, 0.90, 0.95, and 0.93 for patellar, femoral, and tibial components, respectively) 22 …”

Section: Methodsmentioning

confidence: 99%

“…Radiographic techniques can provide information on the component–bone interface through the presence of periprosthetic radiolucencies, but there is little information on the diagnostic performance of radiography to assess implant loosening 19 . An emerging method for studying implant fixation is magnetic resonance imaging (MRI) 20–23 . Improved techniques for reducing the encoding distortions induced by the metallic components have made it possible to assess the component–bone interface, allowing radiologists to classify an implant as loose based on the quality and quantity of osseous integration.…”

Section: Introductionmentioning

confidence: 99%

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A multimodal assessment of cementless tibial baseplate fixation using radiography, radiostereometric analysis, and magnetic resonance imaging

Broberg

Koff

Howard

et al. 2023

Journal Orthopaedic Research

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Fixation in cementless total knee arthroplasty is provided by osseous integration. Radiography, radiostereometric analysis (RSA), and magnetic resonance imaging (MRI) were used simultaneously to investigate fixation. Relationships between RSA‐measured implant micromotions and MRI‐evaluated osseous integration at the component–bone interface were assessed in 10 patients up to 6 months postoperation. Supine MRI (using multispectral imaging sequences) and RSA exams were performed to evaluate osseous integration and measure longitudinal migration, respectively. Inducible displacement was measured from standing RSA exams. Radiolucent lines were detected on conventional radiographs. Of 10 patients, 6 had fibrous membranes detected on MRI. No fluid or osteolytic interfaces were found, and no components were scored loose. Of 10 patients, 6 had radiolucent lines detected. Average maximum total point motion (MTPM) for longitudinal migration at 6 months was 0.816 mm (range 0.344–1.462 mm). Average MTPM for inducible displacement at 6 months was 1.083 mm (range 0.553–1.780 mm). Fictive points located in fibrous‐classified baseplate quadrants had greater longitudinal migration than fictive points located in baseplate quadrants with normal interfaces at 2 weeks (p = 0.031), 6 weeks (p = 0.046), and 3 months (p = 0.047), and greater inducible displacements at 3 months (p = 0.011) and 6 months (p = 0.045). Greater early micromotion may be associated with the presence of fibrous membranes at the component–bone interface. Clinical significance: This multimodal imaging study contributes knowledge of the fixation of modern cementless TKA, supporting the notion that osseous integration is important for optimal implant fixation.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A multimodal assessment of cementless tibial baseplate fixation using radiography, radiostereometric analysis, and magnetic resonance imaging

Broberg

Koff

Howard

et al. 2023

Journal Orthopaedic Research

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MRI and SPECT/CT demonstrate, with low certainty of evidence, the highest diagnostic accuracy for aseptic knee arthroplasty loosening: A systematic comparative diagnostic test review and meta‐analysis

Buijs,

Kooijenga,

Rikken

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to evaluate and compare the diagnostic accuracy of modalities used to aid the diagnosis of aseptic knee arthroplasty loosening.MethodsA comparative diagnostic test accuracy systematic review and meta‐analysis was conducted following the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines. PubMed, EMBASE and Cochrane databases were searched for original articles evaluating diagnostic modalities up to March 2024. Included studies compared the modality (index test) to the intraoperative finding as reference test. The QUADAS‐C (Quality Assessment of Diagnostic Accuracy Studies‐Comparative) tool was used to assess the quality of the included studies. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to evaluate the certainty of evidence. Level of evidence was evaluated using the Oxford Levels of Evidence tool. The primary outcome was the summary of diagnostic accuracy metrics for each modality as demonstrated by a summary receiver‐operating characteristic (SROC) curve.ResultsThe search yielded 467 articles. Of these, 14 articles were included. These 14 articles evaluated a total of five different diagnostic modalities: bone scintigraphy (three studies, 146 cases), 18‐fluorodeoxyglucose positron emission tomography (two studies, 50 cases), single‐photon emission computed tomography combined with computed tomography (SPECT/CT) (seven studies, 371 cases), radionuclide arthrogram (three studies, 196 cases) and magnetic resonance imaging (MRI) (one study, 116 cases). Nine studies exhibited a high risk of bias in patient selection, and all studies showed a high risk of bias related to the reference test. The majority of the included studies were classified as Level III evidence, leading to an overall low level of certainty in the evidence. The most accurate tests, as demonstrated by the SROC analysis, were MRI and SPECT/CT, with sensitivities ranging from 0.00 to 1.00 and 0.33 to 1.00 and specificities between 0.31–1.00 and 0.00–1.00, respectively.ConclusionsThis review and meta‐analysis evaluated available diagnostic modalities to aid the diagnosis of knee arthroplasty loosening and based on a low certainty of evidence suggests that MRI and SPECT/CT are currently the most accurate modalities available to aid the diagnosis of aseptic loosening of knee arthroplasty components.Level of EvidenceLevel III.

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Imaging of Total Knee Arthroplasty

Sosner,

Madoff

2024

Revision Total Knee Arthroplasty

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Diagnostic Performance of MRI for Component Loosening in Total Knee Arthroplasty Compared with Radiography

Cited by 15 publications

References 25 publications

A multimodal assessment of cementless tibial baseplate fixation using radiography, radiostereometric analysis, and magnetic resonance imaging

A multimodal assessment of cementless tibial baseplate fixation using radiography, radiostereometric analysis, and magnetic resonance imaging

MRI and SPECT/CT demonstrate, with low certainty of evidence, the highest diagnostic accuracy for aseptic knee arthroplasty loosening: A systematic comparative diagnostic test review and meta‐analysis

Imaging of Total Knee Arthroplasty

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