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Weissman BN, Palestro CJ, Fox MG, Bell AM, Blankenbaker DG, Frick MA, Jawetz ST, Kuo PH, Said N, Stensby JD, Subhas N, Tynus KM, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria® Imaging After Total Hip Arthroplasty. J Am Coll Radiol 2023; 20:S413-S432. [PMID: 38040462 DOI: 10.1016/j.jacr.2023.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
This article reviews evidence for performing various imaging studies in patients with total hip prostheses. Routine follow-up is generally performed with radiography. Radiographs are also usually the initial imaging modality for patients with symptoms related to the prosthesis. Following acute injury with pain, noncontrast CT may add information to radiographic examination regarding the presence and location of a fracture, component stability, and bone stock. Image-guided joint aspiration, noncontrast MRI, and white blood cell scan and sulfur colloid scan of the hip, are usually appropriate studies for patients suspected of having periprosthetic infection. For evaluation of component loosening, wear, and/or osteolysis, noncontrast CT or MRI are usually appropriate studies. Noncontrast MRI is usually appropriate for identifying adverse reaction to metal debris related to metal-on-metal articulations. For assessing patients after hip arthroplasty, who have trochanteric pain and nondiagnostic radiographs, ultrasound, or MRI are usually appropriate studies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | | | - Angela M Bell
- Rush University Medical Center, Chicago, Illinois; American College of Physicians
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Phillip H Kuo
- University of Arizona, Tucson, Arizona; Commission on Nuclear Medicine and Molecular Imaging
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Katherine M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Hjorth MH, Mechlenburg I, Soballe K, Rømer L, Jakobsen SS, Stilling M. The anatomical location of cystic pseudotumors and muscle atrophy in metal-on-metal resurfacing hip arthroplasty is related to the surgical approach used for implantation. A subgroup analyses of a randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:5967-5976. [PMID: 36802238 DOI: 10.1007/s00402-023-04788-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Pseudotumors and muscle atrophy have been associated with metal-on-metal (MoM) resurfacing hip arthroplasty (RHA). We aimed to investigate the influence of the anterolateral (AntLat) and the posterior (Post) surgical approach on the location, grade and prevalence of pseudotumors and muscle atrophy in MoM RHA. PATIENTS AND METHODS Forty-nine patients were randomized to MoM RHA by the AntLat (n = 25) or the Post (n = 24) approach at Aarhus University Hospital. Patients underwent metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) scans for investigation of location, grade and prevalence of pseudotumors and muscle atrophy. Plain radiographs, metal-ions concentrations and clinical outcome scores were evaluated to compare outcomes of the surgical approaches. RESULTS MRI-detected pseudotumors were seen in 7 of 18 patients (39%) in the AntLat group and in 12 of 22 patients (55%) in the Post group (p = 0.33). Pseudotumors were mainly located anterolaterally to the hip joint in the AntLat group and postero-lateral to the hip joint in the Post group. Higher grades of muscle atrophy of the caudal part of the gluteus medius and minimus (p < 0.004) were seen in the AntLat group, and higher grades of muscle atrophy of the small external rotators were seen in the Post group (p < 0.001). The AntLat group had higher anteversion angles of mean 15.3° (range 6.1-7.5) versus mean 11.5° (range 4.9-22.5) in the Post group (p = 0.02). Metal-ion concentrations and clinical outcome scores were similar between groups (p > 0.08). CONCLUSION Muscle atrophy and pseudotumor location after MoM RHA follow the surgical approach used for implantation. This knowledge may help differentiate between "normal postoperative appearance" and "MoM disease."
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Affiliation(s)
- Mette Holm Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Inger Mechlenburg
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Kjeld Soballe
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Klemt C, Limmahakhun S, Bounajem G, Melnic CM, Harvey MJ, Kwon YM. Outcome of revision surgery for adverse local tissue reactions in patients with recalled total hip arthroplasty. Arch Orthop Trauma Surg 2022; 142:2577-2583. [PMID: 33837474 DOI: 10.1007/s00402-021-03891-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/31/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Recalls of total hip arthroplasty (THA) implants, including metal-on-metal (MoM) THA and dual taper stems, due to increased risk of adverse local tissue reaction (ALTR), represent a challenge for both surgeons and patients. This study aims to analyze the revision surgery outcomes for ALTR in patients with recalled THA implants. METHODS A total of 118 consecutive patients who underwent revision surgery due to ALTR with recalled THA were analyzed. Sub-group analysis was performed for recalled MoM THAs, head-neck modular stems, and dual taper neck-stems. RESULTS At a mean follow-up of 6.6 years, the complication and reoperation rates of the recalled THAs were 32.2% and 25.4% respectively. The most common post-revision complication was dislocation (16%). Revision of modular taper corrosion THA and high-grade intraoperative tissue damage were risk factors associated with post-revision complications. CONCLUSION This study reports high complication and reoperation rates of recalled THAs at mid-term follow-up. The high revision surgery complication rates in both groups suggest the importance of a systematic evaluation of all THA patients with at-risk implants. LEVEL OF EVIDENCE Level III, case control retrospective analysis.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Sakkadech Limmahakhun
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Georges Bounajem
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Christopher M Melnic
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Michael J Harvey
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
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Pemberton MA, Kimber I. Methyl methacrylate and respiratory sensitisation: a comprehensive review. Crit Rev Toxicol 2022; 52:139-166. [PMID: 35607993 DOI: 10.1080/10408444.2022.2064267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Methyl methacrylate (MMA) is classified under GHS as a weak skin sensitiser and a skin and respiratory irritant. It has recently been proposed that MMA be classified as a respiratory sensitiser (a designation that in a regulatory context embraces both true respiratory allergens, as well as chemicals that cause asthma through non-immunological mechanisms). This proposal was based primarily upon the interpretation of human data. This review, and a detailed weight of evidence analysis, has led to another interpretation of these data. The conclusion drawn is that persuasive evidence consistent with the designation of MMA as a respiratory sensitiser is lacking. It is suggested that one reason for different interpretations of these data is that occupational asthma poses several challenges with respect to establishing causation. Among these is that it is difficult to distinguish between allergic asthma, non-allergic asthma, and work-related exacerbation of pre-existing asthma. Moreover, there is a lack of methods for the identification of true chemical respiratory allergens. The characterisation and causation of occupational asthma is consequently largely dependent upon interpretation of human data of various types. Recommendations are made that are designed to improve the utility and interpretation of human data for establishing causation in occupational asthma.
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Affiliation(s)
| | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Agarwala S, Vijayvargiya M. Predictive factors affecting long-term survivorship of ASR metal-on-metal total hip arthroplasty. SICOT J 2021; 7:51. [PMID: 34668856 PMCID: PMC8527991 DOI: 10.1051/sicotj/2021040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/14/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION We present the outcome of 154 ASR (Articular Surface Replacement) hips performed at the P.D Hinduja Hospital and Medical Research Centre in terms of revision rate, metal ion levels, and factors affecting survivorship. Further, determined the importance of serial metal ion estimation over single value with poorly functioning arthroplasties. METHODS A retrospective study of 154 ASR arthroplasties (136 patients) performed from April 2005 till March 2010 was conducted. Ninety-seven patients were available for final analysis. All patients were assessed for symptoms, radiographs, blood metal (chromium and cobalt), metal artefact reduction sequence (MARS), magnetic resonance imaging (MRI), and computerized tomography (CT). RESULTS Female gender, smaller femoral head, patients with a rising level of metal ion levels were more likely to have revision surgery. However, abnormal acetabular inclination/anteversion was not associated with the occurrence of raised metal ion levels, ARMD (adverse reaction to metal debris) or revision surgery. Patients with raised metal ion levels were more likely to have periprosthetic lucency, ARMD, and revision surgery. Median metal levels increased initially for the first three years. Still, patients who required revision surgery continued to have a metal ion rise until the point when revision surgery was performed. In contrast, patients who had a fall in metal ion levels did not require revision. CONCLUSION A single metal ion value is less predictive of failing arthroplasties; instead, a rising trend of metal ion levels can better delineate arthroplasties which will require revision. ASR hips whose blood ion levels fell after an initial rise and showed a declining trend did well.
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Affiliation(s)
- Sanjay Agarwala
- Chief of Surgery and Director Professional Services, P.D Hinduja Hospital and Medical Research Centre, 400016 Mumbai, India
| | - Mayank Vijayvargiya
- Junior Consultant, Department of Orthopedics, P.D Hinduja Hospital and Medical Research Centre, 400016 Mumbai, India
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Galea VP, Rojanasopondist P, Matuszak SJ, Connelly JW, Ray GS, Madanat R, Muratoglu O, Malchau H. Current evidence from a worldwide, multicentre, follow-up study of the recalled Articular Surface Replacement Hip System. Hip Int 2021; 31:378-387. [PMID: 31746236 DOI: 10.1177/1120700019887726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Our first aim was to report the longitudinal clinical performance of patients treated with the ASR Hip System, a metal-on-metal (MoM) device, in their mid- to late-term follow-up. Secondly, we sought to report on the reasons and risk factors for mid- to late-term implant failure. METHODS A total of 1721 ASR patients (1933 hips) from 16 centres in 6 countries were enrolled to a prospective, post-recall study. The average time to enrollment was 7.4 years from index surgery. Data from 3 follow-up visits over 2 years were analysed. Implant performance, based on ion levels and PROMs, was determined at each clinical visit. RESULTS The proportion of those exhibiting good performance decreased over time for hip resurfacing (ASR HRA) and total hip arthroplasty (ASR XL) patients. ASR XL patients were likely to exhibit longitudinal blood metal ion increases regardless of symptom state. ASR HRA patients were more likely to present with and maintain good performance over time, especially males with high general health indicators. 6% of ASR HRA and 14% of ASR XL patients were revised throughout the study period. DISCUSSION ASR XL THA patients are likely to exhibit blood metal ion increases without accompanying changes in symptom state, and therefore should be followed with annual blood tests at minimum. While appropriately selected ASR HRA patients were the most likely to exhibit low blood metal ion levels and report no symptoms, we recommend vigilant follow-up of all ASR patients to ensure that worsening clinical outcomes and asymptomatic soft tissue damage are not missed.
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Affiliation(s)
- Vincent P Galea
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | | | - Sean J Matuszak
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - James W Connelly
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Gabrielle S Ray
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Rami Madanat
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Orhun Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
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Laaksonen I, Galea VP, Connelly JW, Matuszak SJ, Marega L, Madanat R, Muratoglu O, Malchau H. Progression of adverse local tissue reaction in ASR metal-on-metal hip arthroplasty: a longitudinal MARS-MRI study at mid- to long-term. Hip Int 2021; 31:369-377. [PMID: 31868016 DOI: 10.1177/1120700019894668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite the large number of studies assessing adverse local tissue reaction (ALTR) in metal-on-metal (MoM) hip implants, there is still a lack of knowledge about the natural progression of ALTR. The aims of this study were to describe the natural course of changes in ALTR at mid- to long-term follow-up for patients treated with metal-on-metal hip arthroplasty and to determine possible risk factors associated with change in ALTR. METHODS A total of 158 patients (158 hips), 109 MoM hip resurfacing arthroplasties (HRAs) and 49 MoM total hip arthroplasties (THAs), with 2 clinical follow-ups including MARS-MRIs were included. The mean time from index operation to the first visit was 7.6 years (range 3.4-11.4 years), and the mean time between the 2 visits was 1.0 year (range 0.7-1.6 years). RESULTS The proportion of patients with moderate or severe ALTR did not increase significantly between the first and second visit for the MoM HRA group (14.7-15.6%; p = 0.850) or the MoM THA group (32.7-36.7%; p = 0.671). 8 (7.3%) HRA patients and 9 (18.4%) THA patients progressed in ALTR grade. None of the collected clinical variables was sensitive or specific in identifying patients with ALTR progression. CONCLUSIONS Although ALTR prevalence was high in our cohort, clinically significant ALTR progression was rare. We were unable to find any predictors associated with ALTR change. This indicates that MARS-MRI remains a valuable tool in the follow-up of patients treated with MoM hip devices in identifying patients who may need revision surgery.
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Affiliation(s)
- Inari Laaksonen
- The Harris Orthopedic Laboratory, Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA, USA
| | - Vincent P Galea
- The Harris Orthopedic Laboratory, Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA, USA
| | - James W Connelly
- The Harris Orthopedic Laboratory, Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA, USA
| | - Sean J Matuszak
- The Harris Orthopedic Laboratory, Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA, USA
| | - Luca Marega
- Casa di Cura S. Anna, Via del Franzone, Brescia, Italy
| | - Rami Madanat
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Sairaalakatu, Vantaa, Finland
| | - Orhun Muratoglu
- The Harris Orthopedic Laboratory, Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA, USA
| | - Henrik Malchau
- The Harris Orthopedic Laboratory, Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA, USA
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Martin JR, Odum SM, Springer BD, Griffin WL. Initial metal ion levels predict risk of elevation in metal on metal total hip arthroplasty. Hip Int 2020; 30:592-597. [PMID: 31288570 DOI: 10.1177/1120700019861544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Screening protocols for asymptomatic patients with metal on metal (MoM) total hip arthroplasty (THA) are evolving. Most surgeons began screening patients around 2010 by obtaining cobalt (Co) and chromium (Cr) metal ion levels. There is currently no data available to guide repeat screening in this familiar clinical scenario. Therefore, the following study evaluated how metal ion levels change after an initial metal ion level in patients with MoM THAs. MATERIALS AND METHODS 171 consecutive patients (265 hips) underwent primary MoM THA. All patients had at least one Co and Cr ion level draw. 84 patients (136 hips) had 2 ion level draws. Ion levels were divided into elevated levels (⩾4.5 ppb) and normal levels (<4.5 ppb). The probability of an ion level returning elevated after an initial normal level was identified. Additionally, a threshold value was determined that reliably identified every patient that did not subsequently rise above 4.5 ppb. RESULTS 12 metal ion levels were ⩾4.5 ppb on the first lab draw. On the second draw, all 12 remained ⩾4.5 ppb. Of the 121 hips with initial metal ion levels <4.5 ppb, 5 metal ion levels became ⩾4.5 ppb. Utilising an initial screening cutoff of 3.0 ppb, no patient was identified with a second lab value ⩾4.5 ppb. DISCUSSION Initial metal ion levels reliably predicted those that would remain elevated or remain normal with a subsequent metal ion level. An initial metal ion level above 3.0 ppb may represent a cutoff at which further workup is necessary.
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Affiliation(s)
| | - Susan M Odum
- OrthoCarolina Research Institute, Charlotte, NC, USA
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Letter to the Editor: Five Hundred Fifty-five Retrieved Metal-on-metal Hip Replacements of a Single Design Show a Wide Range of Wear, Surface Features, and Histopathologic Reactions. Clin Orthop Relat Res 2018; 476:2278-2279. [PMID: 30286002 PMCID: PMC6259999 DOI: 10.1097/corr.0000000000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Laaksonen I, Galea VP, Donahue GS, Matuszak SJ, Muratoglu O, Malchau H. The Cobalt/Chromium Ratio Provides Similar Diagnostic Value to a Low Cobalt Threshold in Predicting Adverse Local Tissue Reactions in Patients With Metal-on-Metal Hip Arthroplasty. J Arthroplasty 2018; 33:3020-3024. [PMID: 29716769 DOI: 10.1016/j.arth.2018.03.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/12/2018] [Accepted: 03/28/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A higher cobalt/chromium (Co/Cr) ratio is thought to be associated with corrosion of the trunnion and increased adverse local tissue reaction (ALTR) risk in patients treated with metal-on-metal (MoM) hip arthroplasty. The main aim of this study was to investigate the diagnostic value of Co/Cr ratio in identifying ALTR in patients treated with MoM hip resurfacing arthroplasty and total hip arthroplasty (THA). METHODS A total of 310 unilateral patients were included. All patients received a metal artifact reduction sequence magnetic resonance imaging to detect ALTR. Blood Co and Cr levels were measured. RESULTS MoM THA patients had a higher Co/Cr ratio than MoM hip resurfacing arthroplasty patients (1.7, interquartile range 1.2-3.1 vs 0.9, interquartile range 0.7-1.3, P < .001). The continuous Co/Cr ratio, continuous Co, and Co ≥ 7 ppb were predictive of ALTR when tested in receiver-operating characteristic analyses. The most sensitive and specific cutoffs were found to be 1.4 for Co/Cr ratio (sensitivity = 80.0%; specificity = 48.7%) and 2.4 ppb for Co (sensitivity = 77.8%; specificity = 46.2%). In multivariate analysis, continuous Co, Co ≥ 7 ppb, and the receiver-operating characteristic analysis-generated cutoffs were associated with ALTR prevalence. CONCLUSION Blood metal ions are strong, but not perfect, predictors of ALTR in patients with MoM hip arthroplasty. Higher Co/Cr ratios are associated with increased risk for ALTR in MoM THA. However, blood Co levels alone are as good a predictor of ALTR as the Co/Cr ratio. The most ALTR-sensitive cutoffs are lower than previously reported in the literature.
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Affiliation(s)
- Inari Laaksonen
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Vincent P Galea
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Gabrielle S Donahue
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Sean J Matuszak
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Orhun Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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Connelly JW, Galea VP, Laaksonen I, Matuszak SJ, Madanat R, Muratoglu O, Malchau H. Indications for MARS-MRI in Patients Treated With Articular Surface Replacement XL Total Hip Arthroplasty. J Arthroplasty 2018; 33:2906-2911. [PMID: 29776852 DOI: 10.1016/j.arth.2018.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to identify which patient and clinical factors are predictive of adverse local tissue reaction (ALTR) and to use these factors to create a highly sensitive algorithm for indicating metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) in Articular Surface Replacement (ASR) XL total hip arthroplasty patients. Our secondary aim was to compare our algorithm to existing national guidelines on when to take MARS-MRI in metal-on-metal total hip arthroplasty patients. METHODS The study consisted of 137 patients treated with unilateral ASR XL implants from a prospective, multicenter study. Patients underwent MARS-MRI regardless of clinical presentation at a mean of 6.2 (range, 3.3-10.4) years from surgery. Univariate and multivariate analyses were conducted to determine which variables were predictive of ALTR. Predictors were used to create an algorithm to indicate MARS-MRI. Finally, we compared our algorithm's ability to detect ALTR to existing guidelines. RESULTS We found a visual analog scale pain score ≥2 (odds ratio [OR] = 2.53; P = .023), high blood cobalt (OR = 1.05; P = .023), and male gender (OR = 2.37; P = .034) to be significant predictors of ALTR presence in our cohort. The resultant algorithm achieved 86.4% sensitivity and 60.2% specificity in detecting ALTR within our cohort. Our algorithm had the highest area under the curve and was the only guideline that was significantly predictive of ALTR (P = .014). CONCLUSION Our algorithm including patient-reported pain and sex-specific cutoffs for blood cobalt levels could predict ALTR and indicate MARS-MRI in our cohort of ASR XL metal-on-metal patients with high sensitivity. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- James W Connelly
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Vincent P Galea
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Inari Laaksonen
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Sean J Matuszak
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Rami Madanat
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Orhun Muratoglu
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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Matuszak SJ, Galea VP, Connelly JW, Christiansen J, Muratoglu O, Malchau H. Periprosthetic acetabular radiolucency progression in mid-term follow-up of the articular surface replacement hip system. Arch Orthop Trauma Surg 2018; 138:1021-1028. [PMID: 29869689 DOI: 10.1007/s00402-018-2962-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Recent registry studies show that aseptic loosening secondary to osteolysis is the second leading cause of hip implant failure in patients implanted with metal-on-metal (MoM) bearings. The primary aim of our study was to report on the progression of acetabular osteolysis during mid-term follow-up in patients treated with MoM hip resurfacing arthroplasty (HRA) and MoM total hip arthroplasty (THA). The secondary aim was to identify independent predictors of osteolytic lesion progression. MATERIALS AND METHODS A total of 805 patients (805 hips) were included in this study (541 MoM HRA, 264 MoM THA) from a prospective, international clinical registry of the Articular Surface Replacement Hip System. Patients were enrolled a median of 6.6 years from surgery. Osteolytic lesion progression was defined either as any lesion developing de novo, or as an existing lesion progressing from radiolucency to osteolysis during the study period (range 0.5-4.3 years). RESULTS The number of cases with any osteolysis or radiolucency was 21 (3.9%) for ASR HRA and 29 (11.0%) for ASR XL THA at enrollment and increased to 69 (12.8%) for ASR HRA and 41 (15.5%) for ASR XL THA after follow-up. Osteolytic lesion progression was found in 66 (12.2%) ASR HRA patients and 31 (11.7%) ASR XL THA patients. Multivariate models determined that lower acetabular version angle (OR 0.963, p = 0.011) and elevated whole blood chromium (OR 1.110, p = 0.044) were independent predictors of osteolytic lesion progression in ASR HRA. CONCLUSION We suggest that physicians of patients implanted with ASR HRA implants closely monitor patients with higher chromium levels and lower version angles, as they are at increased risk for osteolytic lesion progression, and we recommend annual radiographic follow-up on all patients with ASR implants.
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Affiliation(s)
- Sean J Matuszak
- Harris Orthopaedic Laboratory, Orthopaedic Department, Massachusetts General Hospital, 55 Fruit St. GRJ 1231, Boston, MA, 02114-2696, USA
| | - Vincent P Galea
- Harris Orthopaedic Laboratory, Orthopaedic Department, Massachusetts General Hospital, 55 Fruit St. GRJ 1231, Boston, MA, 02114-2696, USA
| | - James W Connelly
- Harris Orthopaedic Laboratory, Orthopaedic Department, Massachusetts General Hospital, 55 Fruit St. GRJ 1231, Boston, MA, 02114-2696, USA
| | - Janus Christiansen
- Harris Orthopaedic Laboratory, Orthopaedic Department, Massachusetts General Hospital, 55 Fruit St. GRJ 1231, Boston, MA, 02114-2696, USA.,Department of Orthopaedic Surgery, Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Orhun Muratoglu
- Harris Orthopaedic Laboratory, Orthopaedic Department, Massachusetts General Hospital, 55 Fruit St. GRJ 1231, Boston, MA, 02114-2696, USA.,Department of Orthopaedic Surgery, Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Orthopaedic Department, Massachusetts General Hospital, 55 Fruit St. GRJ 1231, Boston, MA, 02114-2696, USA. .,Department of Orthopaedic Surgery, Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA.
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13
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Connelly JW, Galea VP, Matuszak SJ, Madanat R, Muratoglu O, Malchau H. Indications for MARS-MRI in Patients Treated With Metal-on-Metal Hip Resurfacing Arthroplasty. J Arthroplasty 2018; 33:1919-1925. [PMID: 29606289 DOI: 10.1016/j.arth.2018.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/11/2018] [Accepted: 01/13/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Currently, there are no universally accepted guidelines on when to obtain metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) in metal-on-metal (MoM) hip resurfacing arthroplasty (HRA) patients. Our primary aims were to identify which patient and clinical factors are predictive of adverse local tissue reaction (ALTR) and create an algorithm for indicating MARS-MRI in patients with Articular Surface Replacement (ASR) HRA. The secondary aim was to compare our algorithm to existing guidelines on when to perform MARS-MRI in MoM HRA patients. METHODS The study cohort consisted of 182 patients with unilateral ASR HRA from a prospective, multicenter study. Subjects received MARS-MRI at a mean of 7.8 years from surgery, regardless of symptoms. We determined which variables were predictive of ALTR and generated cutoffs for each variable. Finally, we created an algorithm to predict ALTR and indicate MARS-MRI in ASR HRA patients using these cutoffs and compared it to existing guidelines. RESULTS We found high blood cobalt (Co) (odds ratio = 1.070; P = .011) and high blood chromium (Cr) (odds ratio = 1.162; P = .002) to be significant predictors of ALTR presence. Our algorithm using a blood Co cutoff of 1.15 ppb and a Cr cutoff of 1.09 ppb achieved 96.6% sensitivity and 35.3% specificity in predicting ALTR, which outperformed the existing guidelines. CONCLUSION Blood Co and Cr levels are predictive of ALTR in ASR HRA patients. Our algorithm considering blood Co and Cr levels predicts ALTR in ASR HRA patients with higher sensitivity than previously established guidelines.
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Affiliation(s)
- James W Connelly
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA
| | - Vincent P Galea
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA
| | - Sean J Matuszak
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA
| | - Rami Madanat
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Orhun Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
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14
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Martin JR, Jennings JM, Watters TS, Levy DL, Miner TM, Dennis DA. Midterm Prospective Comparative Analysis of 2 Hard-on-Hard Bearing Total Hip Arthroplasty Designs. J Arthroplasty 2018; 33:1820-1825. [PMID: 29429884 DOI: 10.1016/j.arth.2018.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Hard-on-hard (HoH) bearing surfaces in total hip arthroplasty (THA) are commonly utilized in younger patients and may decrease mechanical wear compared to polyethylene bearing surfaces. To our knowledge, no study has prospectively compared the 2 most common HoH bearings, ceramic-on-ceramic (CoC) and metal-on-metal (MoM) THA. MATERIALS AND METHODS We prospectively enrolled 40 patients to undergo an MoM THA and 42 patients to undergo a CoC THA utilizing the same acetabular component. Patients were followed up for a minimum of 2 years. Comparative outcomes included clinical scores, revision or reoperation for any reason, complication rates, and radiographic outcomes. RESULTS The average follow-up was significantly longer in the CoC cohort (94 vs 74 months; P = .005). The CoC cohort had significantly improved Harris Hip Scores (95 vs 84; P = .0009) and pain scores (42 vs 34; P = .0003). The revision (0% vs 31%; P = .0001), reoperation (7.5% vs 36%; P = .004), and complication rates (10% vs 56%; P = .0001) were significantly lower in the CoC cohort. There were no statistically significant differences in radiographic parameters. CONCLUSION The clinical outcomes in the CoC cohort exceeded the MoM cohort. It is unlikely that another prospective comparative study of HoH THAs will be conducted. Our midterm results support the use of CoC THA as a viable option that may reduce long-term wear in younger patients. Close surveillance of MoM THA patients is recommended considering the higher failure and complication rates reported in this cohort.
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Affiliation(s)
| | | | | | | | | | - Douglas A Dennis
- Colorado Joint Replacement, Denver, CO; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN; Bioengineering, University of Denver, Denver, CO; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO
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15
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Laaksonen I, Galea VP, Connelly JW, Matuszak SJ, Muratoglu OK, Malchau H. Inferior Radiographic and Functional Outcomes With Modular Stem in Metal-on-Metal Total Hip Arthroplasty. J Arthroplasty 2018; 33:464-469. [PMID: 28947371 DOI: 10.1016/j.arth.2017.08.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Data on the association between stem type and metal-on-metal (MoM) total hip arthroplasty (THA) performance are limited. The aim of this study is to investigate the effect of stem type on the prevalence of osteolysis and radiolucency, blood metal ion levels, and functional outcomes in patients with Articular Surface Replacement THA (ASR XL), a type of MoM THA. METHODS We analyzed 539 unilateral MoM THAs coupled with Summit (48%), Corail (35%), or S-ROM (17%) hip stems at a mean follow-up of 6.4 years. Fifty-four percent of the patients were male, and the mean age was 60 years. We studied radiographs, patient-reported outcome measures, and ion levels. RESULTS Patients with S-ROM hip stems were 3.8 times more likely to have osteolysis (P = .003) and 7.6 times more likely to have radiolucency (P < .001) than those treated with Summit hip stems. In addition, patients treated with S-ROM hip stems scored worse than those with Summit hip stems in 4 of the 5 patient-reported outcome measures: Harris Hip Score, Visual Analog Scale pain, University of California at Los Angeles activity, and EQ-5D index. All these differences were statistically significant and ranged from 5% to 10%, which is clinically significant. CONCLUSION Patients with S-ROM hip stems had inferior functional and radiographic results compared to patients with Summit hip stems. Retrieval studies on large diameter head MoM THA and close follow-up of these patients with hip stems are needed to understand the mechanism causing the differences in outcomes between these stem types.
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Affiliation(s)
- Inari Laaksonen
- Department of Orthopedic Surgery, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Vincent P Galea
- Department of Orthopedic Surgery, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - James W Connelly
- Department of Orthopedic Surgery, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Sean J Matuszak
- Department of Orthopedic Surgery, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Orhun K Muratoglu
- Department of Orthopedic Surgery, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Henrik Malchau
- Department of Orthopedic Surgery, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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16
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Reiner T, Do TD, Klotz MC, Hertzsch F, Seelmann K, Gaida MM, Weber MA, Gotterbarm T. MRI Findings in Patients After Small-Head Metal-on-Metal Total Hip Arthroplasty with a Minimum Follow-up of 10 Years. J Bone Joint Surg Am 2017; 99:1540-1546. [PMID: 28926383 DOI: 10.2106/jbjs.16.01021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Concern has been raised about the late onset of adverse reactions to metal debris (ARMD) in patients with a small-head metal-on-metal total hip replacement. The aims of this study were to assess the frequency and characteristic appearance of ARMD in patients with a small-head (28-mm) metal-on-metal total hip replacement and elevated blood ion levels (>1 μg/L) after a minimum follow-up of 10 years and to analyze the possible risk factors associated with the prevalence of these lesions. METHODS In the present study, we used metal artifact reduction sequence magnetic resonance imaging (MARS MRI) to investigate the cases of 53 patients (66 hips) with a small-head (28-mm) metal-on-metal total hip replacement and elevated blood ion levels at a mean follow-up interval of 15.5 years (range, 10.6 to 19.3 years). Whole blood metal ion levels (cobalt and chromium), clinical outcome scores (Harris hip score), and radiographs were obtained for each patient. Tissue samples from patients who had revision surgery were histologically examined. RESULTS MARS MRI revealed ARMD in 27 hips (41%). Most hips with ARMD (67%) were asymptomatic. ARMD were generally small, with a median lesion size of 2.3 cm (range, 0.3 to 71.4 cm) and predominantly cystic in nature. Multivariate regression analysis revealed positive correlation between cobalt ion levels and the presence of ARMD. In this case series, the risk for the development of ARMD was 2.87 times higher for every 1 μg/L increase of blood cobalt ion concentration (95% confidence interval, 1.01 to 8.17; p = 0.048). CONCLUSIONS In this case series, ARMD were seen in 41% of the hips following small-head metal-on-metal total hip arthroplasty at long-term follow-up, and most patients with ARMD were asymptomatic. Blood cobalt ion levels could be identified as a risk factor for ARMD. However, ARMD also occurred in patients with low metal ion levels. Further studies are necessary to investigate the role of ARMD in asymptomatic patients with this bearing type. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tobias Reiner
- 1Center for Orthopedics, Trauma Surgery and Spinal Cord Injury (T.R., M.C.K., F.H., K.S., and T.G.), and Department of Diagnostic and Interventional Radiology (T.D.D. and M.-A.W.), Heidelberg University Hospital, Heidelberg, Germany 2Institute for Pathology, University of Heidelberg, Heidelberg, Germany
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17
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Cadossi M, Terrando S, Sambri A, Tedesco G, Mazzotti A, Bordini B, De Pasquale D, Faldini C. What should I expect from my recalled Adept Hip Resurfacing? Musculoskelet Surg 2017; 101:249-254. [PMID: 28452042 DOI: 10.1007/s12306-017-0476-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 12/12/2022]
Abstract
"My Hip Resurfacing (HR) has been recalled. What will happen to me?" This is the question of every patient who underwent an implant recall, a highly stressful event for both patients and physicians. Triggered by a 11.64% failure rate at 7 years, a recall process started for Adept HR with head diameter less than 48 mm. We report our experience in the recall process of 40 patients with the above-mentioned components. One patient underwent revision surgery due to an adverse reaction to metal debris at 5-year follow-up. None of the patients were scheduled for revision, with an estimated survival rate of 97.6% at 7 years. Implants were well positioned with an average acetabular inclination angle of 37°. Cobalt and chromium blood levels were below the safety threshold of clinical relevance. Functional scores were excellent. In the case of a well-positioned device with normal ion levels, a good performance of the implant is generally observed. Even if we experienced a very low revision rate, this may certainly get worse over time since not all possible failures are predictable, thus requiring a careful periodic follow-up.
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Affiliation(s)
- Matteo Cadossi
- Orthopaedic Department, Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
| | - Silvio Terrando
- Orthopaedic Department, Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy.
| | - Andrea Sambri
- Orthopaedic Department, Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
| | - Giuseppe Tedesco
- Orthopaedic Department, Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
| | - Antonio Mazzotti
- Orthopaedic Department, Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Lab, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Cesare Faldini
- Orthopaedic Department, Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
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18
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Jungmann PM, Agten CA, Pfirrmann CW, Sutter R. Advances in MRI around metal. J Magn Reson Imaging 2017; 46:972-991. [PMID: 28342291 DOI: 10.1002/jmri.25708] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/03/2017] [Indexed: 01/02/2023] Open
Abstract
The prevalence of orthopedic metal implants is continuously rising in the aging society. Particularly the number of joint replacements is increasing. Although satisfying long-term results are encountered, patients may suffer from complaints or complications during follow-up, and often undergo magnetic resonance imaging (MRI). Yet metal implants cause severe artifacts on MRI, resulting in signal-loss, signal-pileup, geometric distortion, and failure of fat suppression. In order to allow for adequate treatment decisions, metal artifact reduction sequences (MARS) are essential for proper radiological evaluation of postoperative findings in these patients. During recent years, developments of musculoskeletal imaging have addressed this particular technical challenge of postoperative MRI around metal. Besides implant material composition, configuration and location, selection of appropriate MRI hardware, sequences, and parameters influence artifact genesis and reduction. Application of dedicated metal artifact reduction techniques including high bandwidth optimization, view angle tilting (VAT), and the multispectral imaging techniques multiacquisition variable-resonance image combination (MAVRIC) and slice-encoding for metal artifact correction (SEMAC) may significantly reduce metal-induced artifacts, although at the expense of signal-to-noise ratio and/or acquisition time. Adding advanced image acquisition techniques such as parallel imaging, partial Fourier transformation, and advanced reconstruction techniques such as compressed sensing further improves MARS imaging in a clinically feasible scan time. This review focuses on current clinically applicable MARS techniques. Understanding of the main principles and techniques including their limitations allows a considerate application of these techniques in clinical practice. Essential orthopedic metal implants and postoperative MR findings around metal are presented and highlighted with clinical examples. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:972-991.
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Affiliation(s)
- Pia M Jungmann
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Radiology, Technical University of Munich, Munich, Germany
| | - Christoph A Agten
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian W Pfirrmann
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.,Department of Radiology, Technical University of Munich, Munich, Germany
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.,Department of Radiology, Technical University of Munich, Munich, Germany
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