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Clinical Orthopaedics and Related Research®

, Volume 473, Issue 2, pp 574–580 | Cite as

Metal Artifact Reduction Sequence MRI Abnormalities Occur in Metal-on-polyethylene Hips

  • Thomas K. FehringEmail author
  • Keith Fehring
  • Susan M. Odum
Symposium: 2014 Hip Society Proceedings

Abstract

Background

To determine the importance of MRI abnormalities in metal-on-metal (MoM) bearings, it is important to understand the baseline features of this diagnostic tool in conventional metal-on-polyethylene (MoP) bearings.

Questions/purposes

What are the frequency, size, and types of MRI-documented adverse local tissue reactions in asymptomatic patients with MoP bearings?

Methods

We recruited 50 patients 5 years after a MoP total hip arthroplasty from a pool of patients in our joint registry who had a Harris hip score of > 90. To be included, patients had to be without pain and have adequate radiographs. Our data set included 50 asymptomatic patients with MoP bearings who underwent a metal artifact reduction sequence MRI.

Results

MRI abnormalities were seen in 14 of 50 (28%) asymptomatic patients who were studied. Thirteen of the 14 abnormalities were cystic thin-walled lesions with a mean of 18 cm3 (range, 1–79 cm3).

Conclusions

MRI abnormalities were noted in nearly one-third of asymptomatic patients with MoP bearings. Decisions concerning revision of MoM bearings should not be based on isolated MRI findings because MRI abnormalities are commonly seen regardless of bearing type. A number of factors should determine the need for intervention including pain, mechanical symptoms, abductor weakness, component type, component position, and ion levels as well as MRI findings.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Keywords

Polyethylene Wear Mechanical Symptom Adverse Local Tissue Reaction Abductor Weakness Metal Artifact Reduction Sequence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank OrthoCarolina Research Institute, Inc. Special thanks to Rebecca Haug for her hard work and dedication to the study and the study patients.

References

  1. 1.
    Almousa SA, Greidanus NV, Masri BA, Duncan CP, Garbuz DS. The natural history of inflammatory pseudotumors in asymptomatic patients after metal-on-metal hip arthroplasty. Clin Orthop Relat Res. 2013;471:3814–3821.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Bisseling P, Tan T, Lu Z, Campbell PA, Susante JL. The absence of a metal-on-metal bearing does not preclude the formation of a destructive pseudotumor in the hip—a case report. Acta Orthop. 2013;84:437–441.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Cooper HJ, Ranawat AS, Potter HG, Foo LF, Koob TW, Ranawat CS. Early reactive synovitis and osteolysis after total hip arthroplasty. Clin Orthop Relat Res. 2010;468:3278–3285.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Fehring TK, Odum S, Sproul R, Weathersbee J. High frequency of adverse local tissue reactions in asymptomatic patients with metal-on-metal THA. Clin Orthop Relat Res. 2014;472:517–522.PubMedCrossRefGoogle Scholar
  5. 5.
    Hart AJ, Satchithananda K, Liddle AD, Sabah SA, McRobbie D, Henckel J, Cobb JP, Skinner JA, Mitchell AW. Pseudotumors in association with well functioning metal-on-metal hip prostheses. J Bone Joint Surg Am. 2012;94:317–325.PubMedGoogle Scholar
  6. 6.
    Hsu AR, Gross CE, Levine BR. Pseudotumor from modular neck corrosion after ceramic-on-polyethylene total hip arthroplasty. Am J Orthop (Belle Mead NJ). 2012;41:422–426.PubMedGoogle Scholar
  7. 7.
    Lin KH, Lo NN. Failure of polyethylene in total hip arthroplasty presenting as a pelvic mass. J Arthroplasty. 2009;24:1144.e13–1144.e15.Google Scholar
  8. 8.
    Mak KH, Wong TK, Poddar NC. Wear debris from total hip arthroplasty presenting as an intrapelvic mass. J Arthroplasty. 2001;16:674–676.PubMedCrossRefGoogle Scholar
  9. 9.
    Mao X, Tay GH, Godbolt DB, Crawford RW. Pseudotumor in a well-fixed metal-on-polyethylene uncemented hip arthroplasty. J Arthroplasty. 2012;27:493.e13–493.e17.Google Scholar
  10. 10.
    Messana J, Adelani M, Goodman SB. Case report: pseudotumor associated with corrosion of a femoral component with a modular neck and a ceramic-on-polyethylene bearing. J Long Term Eff Med Implants. 2014;24:1–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Potter HG, Nestor BJ, Sofka CM, Ho ST, Peters LE, Salvati EA. Magnetic resonance imaging after total hip arthroplasty: evaluation of periprosthetic soft tissue. J Bone Joint Surg Am. 2004;86:1947–1954.PubMedGoogle Scholar
  12. 12.
    Santavirta S, Hoikka V, Eskola A, Konttinen YT, Paavilainen T, Tallroth K. Aggressive granulomatous lesions in cementless total hip arthroplasty. J Bone Joint Surg Br. 1990;72:980–984.PubMedGoogle Scholar
  13. 13.
    Scully WF, Teeny SM. Pseudotumor associated with metal-on-polyethylene total hip arthroplasty. Orthopedics. 2013;36:e666–670.PubMedCrossRefGoogle Scholar
  14. 14.
    Shilt JS, Rozencwaig R, Wilson MR. Pelvic mass secondary to polyethylene and titanium alloy wear debris resulting in recurrent deep vein thrombosis. J Arthroplasty. 1997;12:946–949.PubMedCrossRefGoogle Scholar
  15. 15.
    Svensson O, Mathiesen EB, Reinholt FP, Blomgren G. Formation of a fulminant soft-tissue pseudotumor after uncemented hip arthroplasty. A case report. J Bone Joint Surg Am. 1988;70:1238–1242.PubMedGoogle Scholar
  16. 16.
    Tallroth K, Eskola A, Santavirta S, Konttinen YT, Lindholm TS. Aggressive granulomatous lesions after hip arthroplasty. J Bone Joint Surg Br. 1989;71:571–575.PubMedGoogle Scholar
  17. 17.
    Walsh AJ, Nikolaou VS, Antoniou J. Inflammatory pseudotumor complicating metal-on-highly cross-linked polyethylene total hip arthroplasty. J Arthroplasty. 2012;27:324.e5–324.e8.Google Scholar
  18. 18.
    Wang JW, Lin CC. Pelvic mass caused by polyethylene wear after uncemented total hip arthroplasty. J Arthroplasty. 1996;11:626–628.PubMedCrossRefGoogle Scholar
  19. 19.
    White LM, Kim JK, Mehta M, Merchant N, Schweitzer ME, Morrison WB, Hutchison CR, Gross AE. Complications of total hip arthroplasty: MR imaging-initial experience. Radiology. 2000;215:254–262.PubMedCrossRefGoogle Scholar
  20. 20.
    Williams DH, Greidanus NV, Masri BA, Duncan CP, Garbuz DS. Prevalence of pseudotumor in asymptomatic patients after metal-on-metal hip arthroplasty. J Bone Joint Surg Am. 2011;93:2164–2171.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Thomas K. Fehring
    • 1
    Email author
  • Keith Fehring
    • 2
  • Susan M. Odum
    • 3
  1. 1.OrthoCarolina Hip and Knee CenterCharlotteUSA
  2. 2.Virginia Commonwealth University Medical CenterWest HospitalRichmondUSA
  3. 3.OrthoCarolina Research InstituteCharlotteUSA

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