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Sacher SE, Baral EC, Wright TM, Bauer TW, Li Q, Padgett DE, Potter HG, Koff MF. Association of Total Hip Arthroplasty Flexural Rigidity With Magnetic Resonance Imaging and Histological Findings. J Arthroplasty 2024:S0883-5403(24)00192-X. [PMID: 38428693 DOI: 10.1016/j.arth.2024.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Modular connections in total hip arthroplasty (THA) offer surgical advantages, but can contribute to implant fretting and corrosion due to micromotion at the head-stem interface. Previous studies implicated lower flexural rigidity as a key contributing factor to THA corrosion and fretting, but none associated flexural rigidity with direct histological evaluation or magnetic resonance imaging (MRI) outcomes. The purpose of this study was to determine how implant flexural rigidity is associated with MRI imaging metrics and histopathological outcomes in patients who have a failed THA. METHODS Patients requiring revision THA surgery underwent preoperative MRIs with 3-dimensional multispectral imaging techniques to suppress metal artifacts. The MRI images were graded for adverse local tissue reactions. For each hip, trunnion flexural rigidity was measured from the retrieved femoral stem, and a periprosthetic tissue sample was retrieved and evaluated using semiquantitative histology. Generalized linear models and analyses of variance were used to assess associations between flexural rigidity and MRI and histology outcomes. RESULTS A total of 106 THA stems were retrieved (46 women and 60 men, age: 68 years (range, 60 to 73 years). After adjustment for length of implantation, flexural rigidity was negatively correlated with histologic aseptic lymphocyte-dominant vasculitis-associated lesion severity (β = -26.27, P = .018), Fujishiro lymphocyte grading (β = -13.4, P = .039), perivascular lymphocyte layers (β = -17.8, P = .022), the grade of tissue organization (β = -22.5, P = .009), the presence of diffuse synovitis (β = -66.5, P = .003), and the presence of lymphoid aggregates (β = -75.9, P = .022). No association was found between MRI metrics and flexural rigidity. CONCLUSIONS Among these implants, decreased trunnion stiffness was associated with increased histologic features of adverse host-mediated soft tissue reactions.
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Affiliation(s)
- Sara E Sacher
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Elexis C Baral
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Timothy M Wright
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Thomas W Bauer
- Hospital for Special Surgery, Department of Pathology and Laboratory Medicine, New York, New York
| | - Qian Li
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Douglas E Padgett
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
| | - Hollis G Potter
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Matthew F Koff
- Hospital for Special Surgery, Department of Radiology, New York, New York
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Sacher SE, Koff MF, Tan ET, Burge A, Potter HG. The role of advanced metal artifact reduction MRI in the diagnosis of periprosthetic joint infection. Skeletal Radiol 2023:10.1007/s00256-023-04483-5. [PMID: 37875571 PMCID: PMC11039568 DOI: 10.1007/s00256-023-04483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
Identification and diagnosis of periprosthetic joint infection (PJI) are challenging, requiring a multi-disciplinary approach involving clinical evaluation, laboratory tests, and imaging studies. MRI is advantageous to alternative imaging techniques due to superior soft tissue contrast and absence of ionizing radiation. However, the presence of metallic implants can cause signal loss and artifacts. Metal artifact suppression (MARS) MRI techniques have been developed that mitigate metal artifacts and improve periprosthetic soft tissue visualization. This paper provides a review of the various MARS MRI techniques, their clinical applicability and accuracy in PJI diagnosis and evaluation, and current challenges and future perspectives.
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Affiliation(s)
- Sara E Sacher
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA.
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA
| | - Alissa Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA.
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Lekkala S, Sacher SE, Taylor EA, Williams RM, Moseley KF, Donnelly E. Increased Advanced Glycation Endproducts, Stiffness, and Hardness in Iliac Crest Bone From Postmenopausal Women With Type 2 Diabetes Mellitus on Insulin. J Bone Miner Res 2023; 38:261-277. [PMID: 36478472 PMCID: PMC9898222 DOI: 10.1002/jbmr.4757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
Individuals with type 2 diabetes mellitus (T2DM) have a greater risk of bone fracture compared with those with normal glucose tolerance (NGT). In contrast, individuals with impaired glucose tolerance (IGT) have a lower or similar risk of fracture. Our objective was to understand how progressive glycemic derangement affects advanced glycation endproduct (AGE) content, composition, and mechanical properties of iliac bone from postmenopausal women with NGT (n = 35, age = 65 ± 7 years, HbA1c = 5.8% ± 0.3%), IGT (n = 26, age = 64 ± 5 years, HbA1c = 6.0% ± 0.4%), and T2DM on insulin (n = 25, age = 64 ± 6 years, HbA1c = 9.1% ± 2.2%). AGEs were assessed in all samples using high-performance liquid chromatography to measure pentosidine and in NGT/T2DM samples using multiphoton microscopy to spatially resolve the density of fluorescent AGEs (fAGEs). A subset of samples (n = 14 NGT, n = 14 T2DM) was analyzed with nanoindentation and Raman microscopy. Bone tissue from the T2DM group had greater concentrations of (i) pentosidine versus IGT (cortical +24%, p = 0.087; trabecular +35%, p = 0.007) and versus NGT (cortical +40%, p = 0.003; trabecular +35%, p = 0.004) and (ii) fAGE cross-link density versus NGT (cortical +71%, p < 0.001; trabecular +44%, p < 0.001). Bone pentosidine content in the IGT group was lower than in the T2DM group and did not differ from the NGT group, indicating that the greater AGE content observed in T2DM occurs with progressive diabetes. Individuals with T2DM on metformin had lower cortical bone pentosidine compared with individuals not on metformin (-35%, p = 0.017). Cortical bone from the T2DM group was stiffer (+9%, p = 0.021) and harder (+8%, p = 0.039) versus the NGT group. Bone tissue AGEs, which embrittle bone, increased with worsening glycemic control assessed by HbA1c (Pen: R2 = 0.28, p < 0.001; fAGE density: R2 = 0.30, p < 0.001). These relationships suggest a potential mechanism by which bone fragility may increase despite greater tissue stiffness and hardness in individuals with T2DM; our results suggest that it occurs in the transition from IGT to overt T2DM. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Sashank Lekkala
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY
| | - Sara E. Sacher
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY
| | - Erik A. Taylor
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY
| | | | - Kendall F. Moseley
- Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eve Donnelly
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY
- Research Division, Hospital for Special Surgery, New York, NY
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Sacher SE, Neri JP, Gao MA, Argentieri EC, Potter HG, Koch KM, Koff MF. MAVRIC based T2 mapping assessment of infrapatellar fat pad scarring in patients with total knee arthroplasty. J Orthop Res 2022; 41:1299-1309. [PMID: 36262013 PMCID: PMC10113607 DOI: 10.1002/jor.25472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/06/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
The infrapatellar fat pad (IPFP) has been implicated as a source of postoperative knee pain. Imaging the IPFP is challenging in patients with total knee arthroplasty (TKA) due to metallic susceptibility artifact. Multi-Acquisition Variable-Resonance Image Combination (MAVRIC)-based T2 Mapping has been developed to mitigate this artifact and can generate quantitative T2 data. Objectives of this study were to (1) measure T2 values of the IPFP in patients with TKAs using a MAVRIC based T2 mapping technique and (2) determine if IPFP T2 values are related to the degree of fat pad scarring or clinical magnetic resonance imaging (MRI) findings. Twenty-eight subjects (10 males, 18 females, Age: 66 + 7.2 years [Mean ± standard deviations]) undergoing clinical MRIs were sequentially recruited. Morphological imaging and quantitative T2 mapping sequences were performed on a clinical 1.5 T scanner. The morphologic images were graded for the presence and severity of fat pad scarring and clinical outcomes. T2 values were calculated in the total fat pad volume, a normal regions of interest (ROI), and an abnormal ROI. T2 values were shortened in the total IPFP volume (p = 0.001) and within abnormal regions (p = 0.003) in subjects with more severe IPFP scarring. The difference between T2 values in normal-abnormal regions was greater in subjects with severe versus no scarring (+1426.1%, p = 0.008). T2 values were elevated in patients with MRI findings of osteolysis (+32.3%, p = 0.02). These findings indicate that MAVRIC-based T2 Mapping may be used as a quantitative biomarker of postoperative IPFP scarring in individuals following TKA.
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Affiliation(s)
- Sara E Sacher
- Hospital for Special Surgery, New York, New York, USA
| | - John P Neri
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | - Kevin M Koch
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Mosich GM, Potter HG, Koff MF, Sacher SE, Mishu M, Westrich GH. Multiacquisition Variable-Resonance Image Combination Magnetic Resonance Imaging to Study Detailed Bone Apposition and Fixation of Cementless Knee System Compared to Cemented Total Knee Replacements. Arthroplast Today 2022; 17:126-131. [PMID: 36082282 PMCID: PMC9445226 DOI: 10.1016/j.artd.2022.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/12/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Gina M. Mosich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Matthew F. Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Sara E. Sacher
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Mithun Mishu
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H. Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
- Corresponding author. Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. Tel.: +1 212 606 1510.
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Sacher SE, Hunt HB, Lekkala S, Lopez KA, Potts J, Heilbronner AK, Stein EM, Hernandez CJ, Donnelly E. Distributions of Microdamage Are Altered Between Trabecular Rods and Plates in Cancellous Bone From Men With Type 2 Diabetes Mellitus. J Bone Miner Res 2022; 37:740-752. [PMID: 35064941 PMCID: PMC9833494 DOI: 10.1002/jbmr.4509] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 01/13/2023]
Abstract
Individuals with type 2 diabetes mellitus (T2DM) have an increased risk of fragility fracture despite exhibiting normal to high bone mineral density (BMD). Conditions arising from T2DM, such as reduced bone turnover and alterations in microarchitecture, may contribute to skeletal fragility by influencing bone morphology and microdamage accumulation. The objectives of this study were (i) to characterize the effect of T2DM on microdamage quantity and morphology in cancellous bone, and (ii) relate the accumulation of microdamage to the cancellous microarchitecture. Cancellous specimens from the femoral neck were collected during total hip arthroplasty (T2DM: n = 22, age = 65 ± 9 years, glycated hemoglobin [HbA1c] = 7.00% ± 0.98%; non-diabetic [non-DM]: n = 25, age = 61 ± 8 years, HbA1c = 5.50% ± 0.4%), compressed to 3% strain, stained with lead uranyl acetate to isolate microdamage, and scanned with micro-computed tomography (μCT). Individual trabeculae segmentation was used to isolate rod-like and plate-like trabeculae and their orientations with respect to the loading axis. The T2DM group trended toward a greater BV/TV (+27%, p = 0.07) and had a more plate-like trabecular architecture (+8% BVplates , p = 0.046) versus non-DM specimens. Rods were more damaged relative to their volume compared to plates in the non-DM group (DVrods /BVrods versus DVplates /BVplates : +49%, p < 0.0001), but this difference was absent in T2DM specimens. Longitudinal rods were more damaged in the non-DM group (DVlongitudinal rods /BVlongitudinal rods : +73% non-DM versus T2DM, p = 0.027). Total damage accumulation (DV/BV) and morphology (DS/DV) did not differ in T2DM versus non-DM specimens. These results provide evidence that cancellous microarchitecture does not explain fracture risk in T2DM, pointing to alterations in material matrix properties. In particular, cancellous bone from men with T2DM may have an attenuated ability to mitigate microdamage accumulation through sacrificial rods. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Sara E Sacher
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
| | - Heather B Hunt
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
| | - Sashank Lekkala
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
| | - Kelsie A Lopez
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
| | - Jesse Potts
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA
| | - Alison K Heilbronner
- Department of Medicine, Endocrinology and Metabolic Bone Service, Hospital for Special Surgery, New York, NY, USA
| | - Emily M Stein
- Department of Medicine, Endocrinology and Metabolic Bone Service, Hospital for Special Surgery, New York, NY, USA
| | - Christopher J Hernandez
- Research Division, Hospital for Special Surgery, New York, NY, USA.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - Eve Donnelly
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, USA.,Research Division, Hospital for Special Surgery, New York, NY, USA
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Moseley KF, Du Z, Sacher SE, Ferguson VL, Donnelly E. Advanced glycation endproducts and bone quality: practical implications for people with type 2 diabetes. Curr Opin Endocrinol Diabetes Obes 2021; 28:360-370. [PMID: 34183538 DOI: 10.1097/med.0000000000000641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Individuals with type 2 diabetes (T2D) are at increased risk of fracture, often despite normal bone density. This observation suggests deficits in bone quality in the setting of abnormal glucose homeostasis. The goal of this article is to review recent developments in our understanding of how advanced glycation end products (AGEs) are incorporated into the skeleton with resultant deleterious effects on bone health and structural integrity in patients with T2D. RECENT FINDINGS The adverse effects of skeletal AGE accumulation on bone remodeling and the ability of the bone to deform and absorb energy prior to fracture have been demonstrated both at the bench as well as in small human studies; however, questions remain as to how these findings might be better explored in large, population-based investigations. SUMMARY Hyperglycemia drives systemic, circulating AGE formation with subsequent accumulation in the bone tissue. In those with T2D, studies suggest that AGEs diminish fracture resistance, though larger clinical studies are needed to better define the direct role of longstanding AGE accumulation on bone strength in humans as well as to motivate potential interventions to reverse or disrupt skeletal AGE deposition with the goal of fracture prevention.
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Affiliation(s)
- Kendall F Moseley
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Zexu Du
- Department of Materials Science and Engineering, Cornell University, Ithaca
| | - Sara E Sacher
- Department of Materials Science and Engineering, Cornell University, Ithaca
| | - Virginia L Ferguson
- Department of Mechanical Engineering, UCB 427
- Biomedical Engineering Program, UCB 422, University of Colorado, Boulder, Colorado, USA
| | - Eve Donnelly
- Department of Materials Science and Engineering, Cornell University, Ithaca
- Research Division, Hospital for Special Surgery, New York, New York
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