, Volume 468, Issue 12, pp 3278-3285
Date: 25 Apr 2010

Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

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Abstract

Background

Little is known about intraarticular pathology following THA prior to the radiographic appearance of osteolysis, primarily due to imaging limitations. MRI has recently been applied to imaging the postarthroplasty hip with the ability to detect periarticular bony and soft tissue pathology; specifically, it is able to detect abnormal synovial patterns and focal bone loss well before the radiographic appearance of osteolysis.

Questions/purposes

We therefore used MRI to determine the incidence of early reactive synovitis and osteolysis in asymptomatic patients after THA, and whether there is an association between these MRI findings and clinical outcomes or radiographic wear measurements at this early stage.

Methods

We recruited 31 patients (33 hips) who underwent routine noncemented THA with one of three types of bearing surfaces: metal-on-cross-linked polyethylene (n = 7), ceramic-on-ceramic (n = 12), and ceramic-on-cross-linked polyethylene (n = 14). Patients underwent specialized MRI at a minimum of 12 months (mean, 23 months; range, 12–37 months) after surgery. MR images were analyzed for the presence of synovitis or osteolysis. WOMAC scores, patient assessment questionnaires, and radiographic wear measurements were correlated with MRI findings.

Results

Reactive synovitis was observed in 13 of 33 patients (39%) and focal osteolysis in one of 33 (3%). The presence of synovitis did not correlate with pain, activity level, patient satisfaction or clinical outcome scales, nor did it correlate with radiographic wear measurements at early followup.

Conclusions

Our observations suggest reactive synovitis is common yet asymptomatic at short-term followup. We do not know either the etiology or the long-term implications of these observations.

One of more of the authors (HJC, ASR, HGP, LFF, CSR) have received funding from The Hip Society for this project.
Each author certifies that his or her institution approved the human protocol for this investigation and 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 Lenox Hill Hospital, New York, NY, and the Hospital for Special Surgery, New York, NY.
Aided by a grant from the Hip Society.