Magnetic resonance imaging after total hip arthroplasty: evaluation of periprosthetic soft tissue.

BACKGROUND The evaluation of periprosthetic osteolysis in patients who have had a total hip arthroplasty is challenging, and traditional imaging techniques, including magnetic resonance imaging and computerized tomography, are limited by metallic artifact. The purpose of the present study was to investigate the use of modified magnetic resonance imaging techniques involving commercially available software to visualize periprosthetic soft tissues, to define the bone-implant interface, and to detect the location and extent of osteolysis. METHODS Twenty-eight hips in twenty-seven patients were examined to assess the extent of osteolysis (nineteen hips), enigmatic pain (five), heterotopic ossification (two), suspected tumor (one), or femoral nerve palsy (one). The results were correlated with conventional radiographic findings as well as with intraoperative findings (when available). RESULTS Magnetic resonance imaging demonstrated the bone-implant interface and the surrounding soft-tissue envelope in all hips. Radiographs consistently underestimated the extent and location of acetabular osteolysis when compared with magnetic resonance imaging. Magnetic resonance imaging also disclosed radiographically occult extraosseous soft-tissue deposits that were similar in signal intensity to areas of osteolysis, demonstrated the relationship of these deposits to adjacent neurovascular structures, and allowed further visualization of hypertrophic synovial deposits that accompanied the bone resorption in twenty-five of the twenty-eight hips. CONCLUSIONS Magnetic resonance imaging is effective for the assessment of the periprosthetic soft tissues in patients who have had a total hip arthroplasty. While not indicated for every patient who has pain at the site of an arthroplasty, these techniques can be effective for the evaluation of the surrounding soft-tissue envelope as well as intracapsular synovial deposits and are more effective than radiographs for the detection and evaluation of osteolysis, thus aiding in clinical management.

[1]  C. Engh,et al.  Interobserver and intraobserver variability in radiographic assessment of osteolysis. , 2002, The Journal of arthroplasty.

[2]  H. Potter,et al.  Magnetic resonance imaging of painful shoulder arthroplasty. , 2002, Journal of shoulder and elbow surgery.

[3]  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.

[4]  A. Gafni,et al.  Reliability and Intraoperative Validity of Preoperative Assessment of Standardized Plain Radiographs in Predicting Bone Loss at Revision Hip Surgery , 2001, The Journal of bone and joint surgery. American volume.

[5]  T. Fehring,et al.  Underestimation of pelvic osteolysis: the value of the iliac oblique radiograph. , 2000, The Journal of arthroplasty.

[6]  A E Gross,et al.  Complications of total hip arthroplasty: MR imaging-initial experience. , 2000, Radiology.

[7]  W. Lew,et al.  Improving the detection of acetabular osteolysis using oblique radiographs. , 1999, The Journal of bone and joint surgery. British volume.

[8]  A. Sonin,et al.  Iliopsoas bursitis: diagnosis by MRI. , 1998, Journal of computer assisted tomography.

[9]  C J Sutherland,et al.  Preoperative description of severe acetabular defects caused by failed total hip replacement. , 1998, Journal of computer assisted tomography.

[10]  C. Engh,et al.  Treatment of Pelvic Osteolysis Associated with a Stable Acetabular Component Inserted without Cement as Part of a Total Hip Replacement* , 1997, The Journal of bone and joint surgery. American volume.

[11]  N. Kagetsu,et al.  Internally stabilized spine: optimal choice of frequency-encoding gradient direction during MR imaging minimizes susceptibility artifact from titanium vertebral body screws. , 1997, Radiology.

[12]  W. Hozack,et al.  Relationship between polyethylene wear, pelvic osteolysis, and clinical symptomatology in patients with cementless acetabular components. A framework for decision making. , 1996, The Journal of arthroplasty.

[13]  C. Lavernia,et al.  Cost-effectiveness of early surgical intervention in silent osteolysis. , 1996, The Journal of arthroplasty.

[14]  H. Potter,et al.  Magnetic resonance imaging of the pelvis. New orthopaedic applications. , 1995, Clinical orthopaedics and related research.

[15]  C. Engh,et al.  Patterns of osteolysis around total hip components inserted with and without cement. , 1995, The Journal of bone and joint surgery. American volume.

[16]  W. Harris,et al.  The problem is osteolysis. , 1995, Clinical orthopaedics and related research.

[17]  C. Engh,et al.  Severe osteolysis of the pelvic in association with acetabular replacement without cement. , 1993, The Journal of bone and joint surgery. American volume.

[18]  N. Ebraheim,et al.  Titanium hip implants for improved magnetic resonance and computed tomography examinations. , 1992, Clinical orthopaedics and related research.

[19]  R Poss,et al.  Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. , 1990, The Journal of bone and joint surgery. American volume.

[20]  B. Wroblewski,et al.  The correlation between the roentgenographic appearance and operative findings at the bone-cement junction of the socket in Charnley low friction arthroplasties. , 1988, Clinical orthopaedics and related research.

[21]  J. V. van Horn,et al.  MR imaging of 22 Charnley-Müller total hip prostheses. , 1986, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[22]  J. LiPuma,et al.  Magnetic resonance imaging of the pelvis. , 1984, Radiologic clinics of North America.

[23]  C. Gentz,et al.  Radiographic versus clinical loosening of the acetabular component in noninfected total hip arthroplasty. , 1984, Clinical orthopaedics and related research.

[24]  H. Amstutz,et al.  "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. , 1979, Clinical orthopaedics and related research.

[25]  J. Charnley,et al.  Radiological demarcation of cemented sockets in total hip replacement. , 1976, Clinical orthopaedics and related research.

[26]  M. Schweitzer,et al.  Pelvic heterotopic ossification: MR imaging characteristics. , 2002, Radiology.

[27]  B. Masri,et al.  Reliability of acetabular bone defect classification systems in revision total hip arthroplasty. , 2001, The Journal of arthroplasty.

[28]  H. D. Huddleston.  Femoral lysis after cemented hip arthroplasty. , 1988, The Journal of arthroplasty.

[29]  C. Sutherland,et al.  Radiographic evaluation of acetabular bone stock in failed total hip arthroplasty. , 1988, The Journal of arthroplasty.