MRI of early symptomatic metal-on-metal total hip arthroplasty: a retrospective review of radiological findings in 20 hips

Toms, Andoni P.; Marshall, T.; Cahir, John; Darrah, Clare; Nolan, John; Donell, Simon T.; Barker, T. H. W.; Tucker, J.K.

doi:10.1016/j.crad.2007.07.012

Cited by 127 publications

(107 citation statements)

References 35 publications

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“…These values are a major improvement on the predictive ability of blood cobalt and chromium ion levels for identifying a failing hip implant, which have sensitivity and specificity of 63% and 86%, respectively [9]. Other groups have used MRI to study soft tissue lesions around MOM hip implants, but none has used quantitative, reproducible MRI features and none has compared findings between groups formed on a histologic diagnosis [5,8,11,27,30,35]. In a retrospective study, Toms et al [30] qualitatively graded adverse reactions as mild, moderate, or severe and commented on features such as fluid or solid content and walls of the lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Other groups have used MRI to study soft tissue lesions around MOM hip implants, but none has used quantitative, reproducible MRI features and none has compared findings between groups formed on a histologic diagnosis [5,8,11,27,30,35]. In a retrospective study, Toms et al [30] qualitatively graded adverse reactions as mild, moderate, or severe and commented on features such as fluid or solid content and walls of the lesions. Hart et al [10] proposed an MRI classification The mixed-type synovial expansion with associated pseudocapsular dehiscence and extensive decompression of synovitis suggests substantial intraoperative damage.…”

Section: Discussionmentioning

confidence: 99%

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MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Nawabi

Gold

Lyman

et al. 2013

Clin Orthop Relat Res

124

132

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Background Adverse local tissue reactions (ALTR) around metal-on-metal (MOM) hip arthroplasties are increasingly being recognized as a cause of failure. These reactions may be associated with intraoperative tissue damage and complication rates as high as 50% after revision. Although MRI can identify ALTR in MOM hips, it is unclear whether the MRI findings predict those at revision surgery.Questions/purposes We therefore (1) identified which MRI characteristics correlated with histologically confirmed ALTR (using the aseptic lymphocytic vasculitisassociated lesions [ALVAL] score) and intraoperative tissue damage and (2) developed a predictive model using modified MRI to detect ALVAL and quantify intraoperative tissue damage. Methods We retrospectively reviewed 68 patients with failed MOM hip arthroplasties who underwent preoperative MRI and subsequent revision surgery. Images were analyzed to determine synovial volume, osteolysis, and synovial thickness. The ALVAL score was used to grade tissue samples, thus identifying a subset of patients with ALTR. Intraoperative tissue damage was graded using a four-point scale. Random forest analysis determined the sensitivity and specificity of MRI characteristics in detecting ALVAL (score C 5) and intraoperative tissue damage. Results Maximal synovial thicknesses and synovial volumes as determined on MRI correlated with the ALVAL score and were higher in cases of severe intraoperative tissue damage. Our MRI predictive model showed sensitivity and specificity of 94% and 87%, respectively, for detecting ALVAL and 90% and 86%, respectively, for quantifying intraoperative tissue damage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Nawabi

Gold

Lyman

et al. 2013

Clin Orthop Relat Res

124

132

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“…Studies have used several radiographic, operative, and histopathologic terms to describe the sterile inflammatory reactions reported in patients with MOM and MOP hip implants. The radiographic terms include pseudotumor [35], fluid collection [38], inflammatory bursa [35], inflammatory lesion [15,37], and effusion [2]. Studies described operative appearances as metallosis [6], fluid collection [38], and solid mass [35].…”

Section: Discussionmentioning

confidence: 99%

“…The radiographic terms include pseudotumor [35], fluid collection [38], inflammatory bursa [35], inflammatory lesion [15,37], and effusion [2]. Studies described operative appearances as metallosis [6], fluid collection [38], and solid mass [35]. Histopathologic terms include aseptic lymphocytic vasculitis-associated lesion [3,42], lymphocyte-dominant immune reaction [42], and adverse reaction to metal wear debris [25].…”

Section: Discussionmentioning

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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“…The presence of similar cystic soft-tissue reactions has been reported in a review of MRI findings in 19 patients (11 females) with early postoperative pain following Co-Cr on Co-Cr alloy THA prostheses (De Puy International Ltd., Leeds, UK) (Toms et al 2008). The median postoperative time to MRI was 35 (11-63) months.…”

Section: Periprosthetic Soft-tissue Massmentioning

confidence: 92%