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MRI with state-of-the-art metal artifact reduction after total hip arthroplasty: periprosthetic findings in asymptomatic and symptomatic patients

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Abstract

Objectives

To assess the spectrum of periprosthetic MRI findings after primary total hip arthroplasty (THA).

Methods

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.

Results

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.

Conclusions

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.

Key Points

• 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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Abbreviations

CS:

Compressed sensing

ETL:

Echo train length

FOV:

Field of view

HASTE:

Half-Fourier acquisition single-shot turbo spin echo

ICC:

Intra-class correlation coefficient

NSA:

Number of signal averages

OIP:

Optimized inversion pulse

SEMAC:

Slice encoding for metal artifact correction

SES:

Slice encoding steps

STIR:

Short τ inversion recovery

TA:

Acquisition time

TE:

Echo time

THA:

Total hip arthroplasty

TI:

Inversion time

TR:

Repetition time

WOMAC:

Western Ontario and McMaster Universities Arthritis Index

References

  1. Burge AJ (2015) Total hip arthroplasty: MR imaging of complications unrelated to metal wear. Semin Musculoskelet Radiol 19:31–39

    Article  PubMed  Google Scholar 

  2. White LM, Kim JK, Mehta M et al (2000) Complications of total hip arthroplasty: MR imaging-initial experience. Radiology 215:254–262

    Article  CAS  PubMed  Google Scholar 

  3. Del Pozo JL, Patel R (2009) Clinical practice. Infection associated with prosthetic joints. N Engl J Med 361:787–794

    Article  PubMed  PubMed Central  Google Scholar 

  4. Roth TD, Maertz NA, Parr JA, Buckwalter KA, Choplin RH (2012) CT of the hip prosthesis: appearance of components, fixation, and complications. Radiographics 32:1089–1107

    Article  PubMed  Google Scholar 

  5. Mulcahy H, Chew FS (2012) Current concepts of hip arthroplasty for radiologists: part 2, revisions and complications. AJR Am J Roentgenol 199:570–580

    Article  PubMed  Google Scholar 

  6. Hayter CL, Koff MF, Potter HG (2012) Magnetic resonance imaging of the postoperative hip. J Magn Reson Imaging 35:1013–1025

    Article  PubMed  Google Scholar 

  7. Toms AP, Marshall TJ, Cahir J et al (2008) MRI of early symptomatic metal-on-metal total hip arthroplasty: a retrospective review of radiological findings in 20 hips. Clin Radiol 63:49–58

    Article  CAS  PubMed  Google Scholar 

  8. Chang CY, Huang AJ, Palmer WE (2015) Radiographic evaluation of hip implants. Semin Musculoskelet Radiol 19:12–20

    Article  PubMed  Google Scholar 

  9. Czerny C, Krestan C, Imhof H, Trattnig S (1999) Magnetic resonance imaging of the postoperative hip. Top Magn Reson Imaging 10:214–220

    Article  CAS  PubMed  Google Scholar 

  10. Otazo R, Nittka M, Bruno M et al (2016) Sparse-SEMAC: rapid and improved SEMAC metal implant imaging using SPARSE-SENSE acceleration. Magn Reson Med. https://doi.org/10.1002/mrm.26342

  11. Potter HG, Foo LF (2006) Magnetic resonance imaging of joint arthroplasty. Orthop Clin North Am 37(361-373):vi–vii

    Google Scholar 

  12. Weiland DE, Walde TA, Leung SB et al (2005) Magnetic resonance imaging in the evaluation of periprosthetic acetabular osteolysis: a cadaveric study. J Orthop Res 23:713–719

    Article  PubMed  Google Scholar 

  13. Walde TA, Weiland DE, Leung SB et al (2005) Comparison of CT, MRI, and radiographs in assessing pelvic osteolysis: a cadaveric study. Clin Orthop Relat Res:138–144

  14. Pfirrmann CW, Notzli HP, Dora C, Hodler J, Zanetti M (2005) Abductor tendons and muscles assessed at MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients. Radiology 235:969–976

    Article  PubMed  Google Scholar 

  15. Fritz J, Lurie B, Miller TT, Potter HG (2014) MR imaging of hip arthroplasty implants. Radiographics 34:E106–E132

    Article  PubMed  Google Scholar 

  16. Lu W, Pauly KB, Gold GE, Pauly JM, Hargreaves BA (2009) SEMAC: slice encoding for metal artifact correction in MRI. Magn Reson Med 62:66–76

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sutter R, Ulbrich EJ, Jellus V, Nittka M, Pfirrmann CW (2012) Reduction of metal artifacts in patients with total hip arthroplasty with slice-encoding metal artifact correction and view-angle tilting MR imaging. Radiology 265:204–214

    Article  PubMed  Google Scholar 

  18. Khodarahmi I, Nittka M, Fritz J (2017) Leaps in technology: advanced MR imaging after total hip arthroplasty. Semin Musculoskelet Radiol 21:604–615

    Article  PubMed  Google Scholar 

  19. Jungmann PM, Agten CA, Pfirrmann CW, Sutter R (2017) Advances in MRI around metal. J Magn Reson Imaging 46:972–991

    Article  PubMed  Google Scholar 

  20. Hargreaves BA, Worters PW, Pauly KB, Pauly JM, Koch KM, Gold GE (2011) Metal-induced artifacts in MRI. AJR Am J Roentgenol 197:547–555

    Article  PubMed  PubMed Central  Google Scholar 

  21. Koch KM, Brau AC, Chen W et al (2011) Imaging near metal with a MAVRIC-SEMAC hybrid. Magn Reson Med 65:71–82

    Article  CAS  PubMed  Google Scholar 

  22. Fritz J, Ahlawat S, Demehri S et al (2016) Compressed Sensing SEMAC: 8-fold accelerated high resolution metal artifact reduction MRI of cobalt-chromium knee arthroplasty implants. Invest Radiol 51:666–676

    Article  CAS  PubMed  Google Scholar 

  23. Otazo R, Nittka M, Bruno M et al (2017) Sparse-SEMAC: rapid and improved SEMAC metal implant imaging using SPARSE-SENSE acceleration. Magn Reson Med 78:79–87

    Article  CAS  PubMed  Google Scholar 

  24. Jungmann PM, Bensler S, Zingg P, Fritz B, Pfirrmann CW, Sutter R (2019) Improved visualization of juxtaprosthetic tissue using metal artifact reduction magnetic resonance imaging: experimental and clinical optimization of Compressed Sensing SEMAC. Invest Radiol 54:23–31

    Article  PubMed  Google Scholar 

  25. Kim CO, Dietrich TJ, Zingg PO, Dora C, Pfirrmann CWA, Sutter R (2017) Arthroscopic hip surgery: frequency of postoperative MR arthrographic findings in asymptomatic and symptomatic patients. Radiology 283:779–788

    Article  PubMed  Google Scholar 

  26. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  27. Johnston RC, Fitzgerald RH Jr, Harris WH, Poss R, Muller ME, Sledge CB (1990) Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg Am 72:161–168

    Article  CAS  PubMed  Google Scholar 

  28. Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res (141):17–27

  29. DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res:20–32

  30. Zanetti M, Bruder E, Romero J, Hodler J (2000) Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology 215:835–840

    Article  CAS  PubMed  Google Scholar 

  31. Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CW (2015) Assessment of femoral antetorsion with MRI: comparison of oblique measurements to standard transverse measurements. AJR Am J Roentgenol 205:130–135

    Article  PubMed  Google Scholar 

  32. Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CW (2012) Femoral antetorsion: comparing asymptomatic volunteers and patients with femoroacetabular impingement. Radiology 263:475–483

    Article  PubMed  Google Scholar 

  33. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  34. Kundel HL, Polansky M (2003) Measurement of observer agreement. Radiology 228:303–308

    Article  PubMed  Google Scholar 

  35. Choi SJ, Koch KM, Hargreaves BA, Stevens KJ, Gold GE (2015) Metal artifact reduction with MAVRIC SL at 3-T MRI in patients with hip arthroplasty. AJR Am J Roentgenol 204:140–147

    Article  PubMed  PubMed Central  Google Scholar 

  36. Filli L, Jud L, Luechinger R et al (2017) Material-dependent implant artifact reduction using SEMAC-VAT and MAVRIC: a prospective MRI phantom study. Invest Radiol 52:381–387

    Article  PubMed  Google Scholar 

  37. Deligianni X, Bieri O, Elke R, Wischer T, Egelhof T (2015) Optimization of scan time in MRI for total hip prostheses: SEMAC tailoring for prosthetic implants containing different types of metals. Rofo 187:1116–1122

    Article  CAS  PubMed  Google Scholar 

  38. Fritz J, Fritz B, Thawait GK et al (2016) Advanced metal artifact reduction MRI of metal-on-metal hip resurfacing arthroplasty implants: compressed sensing acceleration enables the time-neutral use of SEMAC. Skeletal Radiol 45:1345–1356

    Article  PubMed  Google Scholar 

  39. Mulcahy H, Chew FS (2012) Current concepts of hip arthroplasty for radiologists: part 1, features and radiographic assessment. AJR Am J Roentgenol 199:559–569

    Article  PubMed  Google Scholar 

  40. Del Grande F, Santini F, Herzka DA et al (2014) Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system. Radiographics 34:217–233

    Article  PubMed  Google Scholar 

  41. Bosetti M, Masse A, Navone R, Cannas M (2001) Biochemical and histological evaluation of human synovial-like membrane around failed total hip replacement prostheses during in vitro mechanical loading. J Mater Sci Mater Med 12:693–698

    Article  CAS  PubMed  Google Scholar 

  42. Sugimoto H, Hirose I, Miyaoka E et al (2003) Low-field-strength MR imaging of failed hip arthroplasty: association of femoral periprosthetic signal intensity with radiographic, surgical, and pathologic findings. Radiology 229:718–723

    Article  PubMed  Google Scholar 

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Correspondence to Lukas Filli.

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The scientific guarantor of this publication is Lukas Filli.

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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.

Informed consent

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.

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Institutional Review Board approval was obtained.

Methodology

• Prospective

• 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

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  • DOI: https://doi.org/10.1007/s00330-019-06554-5

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