To assess the spectrum of periprosthetic MRI findings after primary total hip arthroplasty (THA).
This multi-center cohort study analyzed 31 asymptomatic patients (65.7 ± 12.7 years) and 27 symptomatic patients (62.3 ± 11.9 years) between 6 months and 2 years after THA. 1.5-T MRI was performed using Compressed Sensing SEMAC and high-bandwidth sequences. Femoral stem and acetabular cup were assessed for bone marrow edema, osteolysis, and periosteal reaction in Gruen zones and DeLee and Charnley zones. Student t test and Fisher’s exact test were performed.
The asymptomatic and symptomatic groups showed different patterns of imaging findings. Bone marrow edema was seen in 19/31 (61.3%) asymptomatic and 22/27 (81.5%) symptomatic patients, most commonly in Gruen zones 1, 7, and 8 (p ≥ 0.18). Osteolysis occurred in 14/31 (45.2%) asymptomatic and 14/27 (51.9%) symptomatic patients and was significantly more common in Gruen zone 7 in the symptomatic group (8/27 (29.6%)) compared to the asymptomatic group (2/31 (6.5%)) (p = 0.03). Periosteal reaction was present in 4/31 asymptomatic (12.9%) and 9/27 symptomatic patients (33.3%) and more common in Gruen zones 5 and 6 in the symptomatic group (p = 0.04 and 0.02, respectively). In the acetabulum, bone marrow edema pattern was encountered in 3/27 (11.1%) symptomatic patients but not in asymptomatic patients (p ≥ 0.21). Patient management was altered in 8/27 (29.6%) patients based on MRI findings.
Periprosthetic bone marrow edema is common after THA both in asymptomatic and symptomatic patients. Osteolysis and periosteal reaction are more frequent in symptomatic patients. MRI findings led to altered patient management in 29.6% of patients.
• Bone marrow edema pattern was frequent in both asymptomatic and symptomatic patients after THA, particularly around the proximal femoral stem in Gruen zones 1, 7, and 8.
• Osteolysis was significantly more frequent in symptomatic patients in Gruen zone 7.
• Periosteal reaction occurred more frequently in symptomatic patients in Gruen zones 5 and 6.
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Echo train length
Field of view
Half-Fourier acquisition single-shot turbo spin echo
Intra-class correlation coefficient
Number of signal averages
Optimized inversion pulse
Slice encoding for metal artifact correction
Slice encoding steps
Short τ inversion recovery
Total hip arthroplasty
Western Ontario and McMaster Universities Arthritis Index
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The authors state that this work has not received any funding.
The scientific guarantor of this publication is Lukas Filli.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all prospectively included asymptomatic subjects in this study. Ethical approval for retrospective inclusion of symptomatic patients was waived by the local ethics committee.
Institutional Review Board approval was obtained.
• Cross-sectional study
• Multi-center study
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Filli, L., Jungmann, P.M., Zingg, P.O. et al. MRI with state-of-the-art metal artifact reduction after total hip arthroplasty: periprosthetic findings in asymptomatic and symptomatic patients. Eur Radiol 30, 2241–2252 (2020). https://doi.org/10.1007/s00330-019-06554-5