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

  • Symposium: Papers Presented at the Annual Meetings of The Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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 vasculitis-associated 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 ≥ 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.

Conclusions

MRI is sensitive and specific in detecting ALVAL and tissue damage in patients with MOM hip implants. MRI can be used as a screening tool to guide surgeons toward timely revision surgery.

Level of Evidence

Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowldgments

We thank Alissa Burge MD for assistance with the MRI analysis, Matthew Koff PhD for help with the statistical analysis, and Giorgio Perino MD for grading the histologic samples.

Author information

Authors and Affiliations

  1. Adult Reconstruction and Joint Replacement Division Surgery, Hospital for Special Surgery, New York, NY, USA

    Danyal H. Nawabi MD, FRCS(Orth) & Douglas E. Padgett MD

  2. Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Stephanie Gold BA & Hollis G. Potter MD

  3. Epidemiology and Biostatistics Core, Hospital for Special Surgery, New York, NY, USA

    Steven Lyman PhD & Kara Fields MS

  4. Weill Cornell Medical College of Cornell University, New York, NY, USA

    Steven Lyman PhD, Douglas E. Padgett MD & Hollis G. Potter MD

Authors
  1. Danyal H. Nawabi MD, FRCS(Orth)
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Corresponding author

Correspondence to Hollis G. Potter MD.

Additional information

The institution of one or more of the authors (HGP) has received, during the study period, funding from General Electric Healthcare (Waukesha, WI, USA). One of the authors certifies that he (DEP), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount less than $10,000 from Stryker (Mahwah, NJ, USA), and an amount of $10,000–$100,000 from Mako (Fort Lauderdale, FL, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Hospital for Special Surgery, New York, NY, USA.

Appendix

Appendix

Appendix 1 Scoring sheet used to evaluate patients with a metal-on-metal hip arthroplasty
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Nawabi, D.H., Gold, S., Lyman, S. et al. MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty. Clin Orthop Relat Res 472, 471–481 (2014). https://doi.org/10.1007/s11999-013-2788-y

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  • DOI: https://doi.org/10.1007/s11999-013-2788-y

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