Cross-sectional imaging of metal-on-metal hip arthroplasties

Background and purpose — Metal artifact reduction sequence (MARS) MRI is widely advocated for surveillance of metal-on-metal hip arthroplasties (MOM-HAs). However, its use is limited by susceptibility artifact at the prosthesis-bone interface, local availability, patient compliance, and cost (Hayter et al. 2011a). We wanted to determine whether CT is a suitable substitute for MARS MRI in evaluation of the painful MOM-HA. Patients and methods — 50 MOM-HA patients (30 female) with unexplained painful prostheses underwent MARS MRI and CT imaging. 2 observers who were blind regarding the clinical data objectively reported the following outcomes: soft tissue lesions (pseudotumors), muscle atrophy, and acetabular and femoral osteolysis. Diagnostic test characteristics were calculated. Results — Pseudotumor was diagnosed in 25 of 50 hips by MARS MRI and in 11 of 50 by CT. Pseudotumors were classified as type 1 (n = 2), type 2A (n = 17), type 2B (n = 4), and type 3 (n = 2) by MARS MRI. CT did not permit pseudotumor classification. The sensitivity of CT for diagnosis of pseudotumor was 44% (95% CI: 25–65). CT had “slight” agreement with MARS MRI for quantification of muscle atrophy (κ = 0.23, CI: 0.16–0.29; p < 0.01). Osteolysis was identified in 15 of 50 patients by CT. 4 of these lesions were identified by MARS MRI. Interpretation — CT was found to be superior to MRI for detection of osteolysis adjacent to MOM-HA, and should be incorporated into diagnostic algorithms. CT was unable to classify and failed to detect many pseudotumors, and it was unreliable for assessment of muscle atrophy. Where MARS MRI is contraindicated or unavailable, CT would be an unsuitable substitute and other modalities such as ultrasound should be considered

[1]  Matthew F Koff,et al.  MRI after arthroplasty: comparison of MAVRIC and conventional fast spin-echo techniques. , 2011, AJR. American journal of roentgenology.

[2]  H. Potter,et al.  MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty , 2014, Clinical orthopaedics and related research.

[3]  Lorrie Faith Cranor,et al.  email , 1995, CROS.

[4]  H. Potter,et al.  Magnetic resonance imaging of the postoperative hip , 2012, Journal of magnetic resonance imaging : JMRI.

[5]  Young Soo Chun,et al.  Focal osteolysis in total hip replacement: CT findings , 2004, Skeletal Radiology.

[6]  B. Kollen,et al.  High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. , 2012, The Journal of bone and joint surgery. British volume.

[7]  H. Potter,et al.  MRI findings in painful metal-on-metal hip arthroplasty. , 2012, AJR. American journal of roentgenology.

[8]  H. Potter,et al.  Imaging of metal-on-metal hip resurfacing. , 2011, The Orthopedic clinics of North America.

[9]  S David Stulberg,et al.  Use of Helical Computed Tomography for the Assessment of Acetabular Osteolysis After Total Hip Arthroplasty , 2002, The Journal of bone and joint surgery. American volume.

[10]  H. Gill,et al.  A MRI classification of periprosthetic soft tissue masses (pseudotumours) associated with metal-on-metal resurfacing hip arthroplasty , 2012, Skeletal Radiology.

[11]  Andrej Cör,et al.  Survivorship and retrieval analysis of Sikomet metal-on-metal total hip replacements at a mean of seven years. , 2006, The Journal of bone and joint surgery. American volume.

[12]  A. Liddle,et al.  Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging. , 2012, The Journal of bone and joint surgery. American volume.

[13]  A. Toms,et al.  CT and MRI of hip arthroplasty. , 2007, Clinical radiology.

[14]  B. Bal,et al.  Muscle damage in minimally invasive total hip arthroplasty: MRI evidence that it is not significant. , 2008, Instructional course lectures.

[15]  M. Nittka,et al.  Reduction of metal artifacts in patients with total hip arthroplasty with slice-encoding metal artifact correction and view-angle tilting MR imaging. , 2012, Radiology.

[16]  Marianna S. Thomas,et al.  Imaging Metal-on-Metal Hip Replacements: the Norwich Experience , 2013, HSS Journal ®.

[17]  M. Porter,et al.  Report of the Expert Advisory Group looking at soft tissue reactions associated with metal-on-metal hip replacements. , 2010 .

[18]  H. Gill,et al.  Hip resurfacings revised for inflammatory pseudotumour have a poor outcome. , 2009, The Journal of bone and joint surgery. British volume.

[19]  Bal Bs,et al.  Muscle damage in minimally invasive total hip arthroplasty: MRI evidence that it is not significant. , 2008 .

[20]  Jacob T. Munro,et al.  High Complication Rate After Revision of Large-head Metal-on-metal Total Hip Arthroplasty , 2014, Clinical orthopaedics and related research.

[21]  Ashley Carr,et al.  OSTEOLYSIS IN PATIENTS WITH A METAL‐ON‐METAL HIP ARTHROPLASTY , 2008, ANZ journal of surgery.

[22]  M. Wimmer,et al.  European multidisciplinary consensus statement on the use and monitoring of metal-on-metal bearings for total hip replacement and hip resurfacing. , 2013, Orthopaedics & traumatology, surgery & research : OTSR.

[23]  J. Henckel,et al.  Can we substitute MARS MRI with CT , 2014 .

[24]  Seung-Jae Lim,et al.  Early osteolysis following second-generation metal-on-metal hip replacement. , 2005, The Journal of bone and joint surgery. American volume.

[25]  S. Donell,et al.  MRI of early symptomatic metal-on-metal total hip arthroplasty: a retrospective review of radiological findings in 20 hips. , 2008, Clinical radiology.

[26]  Johann Henckel,et al.  A comparison of the diagnostic accuracy of MARS MRI and ultrasound of the painful metal-on-metal hip arthroplasty , 2014, Acta orthopaedica.

[27]  J. Henckel,et al.  The painful metal-on-metal hip resurfacing. , 2009, The Journal of bone and joint surgery. British volume.

[28]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[29]  Johann Henckel,et al.  Magnetic resonance imaging findings in painful metal-on-metal hips: a prospective study. , 2011, The Journal of arthroplasty.

[30]  D W Murray,et al.  Pseudotumours associated with metal-on-metal hip resurfacings. , 2008, The Journal of bone and joint surgery. British volume.

[31]  Kenneth A Buckwalter,et al.  CT of the hip prosthesis: appearance of components, fixation, and complications. , 2012, Radiographics : a review publication of the Radiological Society of North America, Inc.

[32]  P. Campbell,et al.  An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. , 2005, The Journal of bone and joint surgery. American volume.

[33]  Hollis G Potter,et al.  What Are the Advantages and Disadvantages of Imaging Modalities to Diagnose Wear-related Corrosion Problems? , 2014, Clinical orthopaedics and related research.

[34]  P. Korovessis,et al.  Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up. , 2006, The Journal of bone and joint surgery. American volume.

[35]  Hollis G Potter,et al.  Comparison of CT, MRI, and Radiographs in Assessing Pelvic Osteolysis: A Cadaveric Study , 2005, Clinical orthopaedics and related research.

[36]  E. Chang,et al.  Metal-on-metal total hip arthroplasty: do symptoms correlate with MR imaging findings? , 2012, Radiology.

[37]  F M Rodriguez y Baena,et al.  Very low-dose computed tomography for planning and outcome measurement in knee replacement. The imperial knee protocol. , 2006, The Journal of bone and joint surgery. British volume.

[38]  A. Toms,et al.  Grading the severity of soft tissue changes associated with metal-on-metal hip replacements: reliability of an MR grading system , 2011, Skeletal Radiology.