Magnetic Resonance Imaging in the Diagnosis and Management of Hip Pain After Total Hip Arthroplasty

Cooper, H. John; Ranawat, Amar S.; Potter, Hollis G.; Foo, Li Foong; Jawetz, Shari T.; Ranawat, Chitranjan S.

doi:10.1016/j.arth.2008.04.023

Cited by 26 publications

(18 citation statements)

References 22 publications

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“…The Medicines and Healthcare products Regulatory Agency has suggested follow up of patients with MOM hips, to include cross-sectional imaging (metal artifact reduction sequence [MARS]-MRI or ultrasound) for the detection of pseudotumors [5,35,37,39]. Pseudotumors are sterile inflammatory masses in the soft tissues surrounding MOM [35,37] and metal-on-polyethylene (MOP) [1,19] hip prostheses.…”

Section: Introductionmentioning

confidence: 99%

Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips

Matthies

Skinner

Osmani

et al. 2012

Clinical Orthopaedics &Amp; Related Research

141

138

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Background Pseudotumors are sterile inflammatory lesions found in the soft tissues surrounding metal-on-metal (MOM) and metal-on-polyethylene hip arthroplasties. In patients with MOM hip arthroplasties, pseudotumors are thought to represent an adverse reaction to metal wear debris. However, the pathogenesis of these lesions remains unclear. Currently, there is inconsistent evidence regarding the influence of adverse cup position and increased wear in the formation of pseudotumors. Questions/purposes We therefore determined whether pseudotumor formation was associated with (1) adverse cup position, (2) raised metal ion levels, and (3) increased wear rates of the retrieved components. Methods We retrospectively reviewed all 352 patients for whom we had retrieved specimens from revisions of a current-generation MOM hip prosthesis between February 2008 and September 2010; of these, 105 met our inclusion criteria. We used multivariate logistic regression analysis to compare acetabular orientation, metal ion levels before revision, and component wear rates between patients with (n = 72) and without (n = 33) pseudotumors, according to findings on metal artifact reduction sequence MRI. Results The proportion of patients demonstrating evidence of a pseudotumor in well-positioned hips was similar to those with adverse cup positions (67% and 66%, respectively). Patients revised with pseudotumors had similar whole-blood metal ion levels and component wear rates to those who were not revised. Conclusions Pseudotumors were not associated with increased wear or metal ion levels, suggesting patient susceptibility is likely to be more important.

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Section: Introductionmentioning

confidence: 99%

Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips

Matthies

Skinner

Osmani

et al. 2012

Clinical Orthopaedics &Amp; Related Research

141

138

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“…MRI is well-documented in its ability to discern abnormal synovial patterns [8,42] and is an accepted imaging modality for this purpose. Intermediate to decreased signal intensity in the synovial lining with distension of the joint capsule was indicative of reactive synovitis [7,39]. These patients showed distention of the normally thin, hypointense pseudocapsule by coarse synovitis which had signal characteristics similar to those of the osteolytic material replacing the bone.…”

Section: Methodsmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

“…In recent years, there have been numerous studies examining its role in imaging THA [3,7,38,39,46,[50][51][52]. MRI is effective for detecting periarticular bony and soft-tissue abnormalities in patients with a postarthroplasty hip [3,39,46,52], as well as determining the source of enigmatic hip following THA [7]. Due to its direct multiplanar capabilities and superior soft-tissue contrast, MRI is able to visualize intracapsular synovitis [7,39,52] and is more sensitive in the detection of osteolytic lesions than radiographs or CT [50,51].…”

Section: Introductionmentioning

confidence: 99%

“…MRI is effective for detecting periarticular bony and soft-tissue abnormalities in patients with a postarthroplasty hip [3,39,46,52], as well as determining the source of enigmatic hip following THA [7]. Due to its direct multiplanar capabilities and superior soft-tissue contrast, MRI is able to visualize intracapsular synovitis [7,39,52] and is more sensitive in the detection of osteolytic lesions than radiographs or CT [50,51]. Specifically, the ability of optimized MRI to detect wear-induced particle disease in the postarthroplasty hip has been documented in two studies that have corroborated this MRI finding with tissue pathology [39,52].…”

Section: Introductionmentioning

confidence: 99%

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Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

Cooper

Ranawat

Potter

et al. 2010

Clinical Orthopaedics &Amp; Related Research

Self Cite

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Background Little is known about intraarticular pathology following THA prior to the radiographic appearance of osteolysis, primarily due to imaging limitations. MRI has recently been applied to imaging the postarthroplasty hip with the ability to detect periarticular bony and soft tissue pathology; specifically, it is able to detect abnormal synovial patterns and focal bone loss well before the radiographic appearance of osteolysis. Questions/purposes We therefore used MRI to determine the incidence of early reactive synovitis and osteolysis in asymptomatic patients after THA, and whether there is an association between these MRI findings and clinical outcomes or radiographic wear measurements at this early stage. Methods We recruited 31 patients (33 hips) who underwent routine noncemented THA with one of three types of bearing surfaces: metal-on-cross-linked polyethylene (n = 7), ceramic-on-ceramic (n = 12), and ceramic-on-cross-linked polyethylene (n = 14). Patients underwent specialized MRI at a minimum of 12 months (mean, 23 months; range, 12-37 months) after surgery. MR images were analyzed for the presence of synovitis or osteolysis. WOMAC scores, patient assessment questionnaires, and radiographic wear measurements were correlated with MRI findings. Results Reactive synovitis was observed in 13 of 33 patients (39%) and focal osteolysis in one of 33 (3%). The presence of synovitis did not correlate with pain, activity level, patient satisfaction or clinical outcome scales, nor did it correlate with radiographic wear measurements at early followup. Conclusions Our observations suggest reactive synovitis is common yet asymptomatic at short-term followup. We do not know either the etiology or the long-term implications of these observations.

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Bone Defects in Acetabular Revision Surgery. Imaging and Classifications

García-Rey

2018

Acetabular Revision Surgery in Major Bone Defects

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Magnetic Resonance Imaging in the Diagnosis and Management of Hip Pain After Total Hip Arthroplasty

Cited by 26 publications

References 22 publications

Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips

Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips

Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

Bone Defects in Acetabular Revision Surgery. Imaging and Classifications

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