Advanced MR Imaging after Total Hip Arthroplasty: The Clinical Impact

AbstractRecent metal artifact reduction techniques in magnetic resonance imaging (MRI) have sparked a new aera in visualization of the peri-implant region and assessment of failing orthopaedic hardware. Modes of failure after total hip arthroplasty can be classified into four broad categories: osseous abnormalities, implant instability and dislocation, implant-associated synovitis, and soft tissue abnormalities. Although MRI is complementary to plain radiography and computed tomography to diagnose the first two categories, it is paramount to investigate the complications related to the synovium and soft tissues. We review the most common modes of failure of hip implants and the MRI characteristics of various causes of pain and dysfunction after hip arthroplasty including osseous stress reaction and fracture, implant loosening, implant instability, polyethylene wear–induced synovitis, adverse reaction to metal debris, infection, hematoma, recurrent hemarthrosis, heterotopic ossification, muscle, tendon, and nerve abnormalities, and periprosthetic neoplasms.

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Small-head metal on metal total hip arthroplasty is associated with a high rate of complication and reoperation at mid-term follow-up

SAGE Open Medicine ◽

10.1177/20503121211014707 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110147

Author(s):

Nobuhiko Sumiyoshi ◽

Kazuhiro Oinuma ◽

Yoko Miura

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Adverse Reactions ◽

Small Diameter ◽

High Rate ◽

Metal Debris ◽

Total Hip ◽

Metal On Metal ◽

Small Head

Background: Adverse reactions to metal debris are significant complications after metal-on-metal total hip arthroplasty. Recently, late appearances of adverse reactions to metal debris and subsequent need for reoperations have been reported with small-diameter head metal-on-metal devices. We retrospectively investigated mid-term clinical outcomes of small-head metal-on-metal total hip arthroplasty. Methods: We reviewed 159 hips in 139 patients who had a small-head metal-on-metal total hip arthroplasty (M2a Taper; Biomet, Warsaw, IN) with a minimum 5-year follow-up and documented postoperative complications. Results: Focal osteolysis in either the femur or acetabulum was observed in 12 hips (7.5%, 44 months after surgery on average), with pseudotumor observed in 8 hips (5%, 120 months after surgery on average). Four hips (2.5%) had dislocations (84 months after surgery on average) and six hips (3.8%, 122 months after surgery on average) underwent reoperation. Conclusion: Small-head metal-on-metal total hip arthroplasty is associated with a high degree of complications at mid-term follow-up period. Considering this, we discourage the use of metal-on-metal total hip arthroplasty regardless of head size.

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Durability of transosseous repair of posterior soft tissues after primary total hip arthroplasty: a prospective randomized controlled trial

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04118-1 ◽

2021 ◽

Author(s):

Erdem Edipoglu

Keyword(s):

Randomized Controlled Trial ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Soft Tissues ◽

Controlled Trial ◽

Total Hip ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial ◽

Transosseous Repair ◽

Primary Total Hip Arthroplasty

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Reliability of Total Nucleated Cell Counts in the Setting of Hip Arthroplasty

The Journal of Applied Laboratory Medicine ◽

10.1093/jalm/jfaa183 ◽

2020 ◽

Author(s):

Lauren N Pearson ◽

Robert L Schmidt ◽

Kenneth Cahoon ◽

Christopher E Pelt

Keyword(s):

Synovial Fluid ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Debris ◽

Total Hip ◽

Cell Counts ◽

History Of ◽

Joint Effusions ◽

Automated Instruments ◽

Automated Methods

Abstract Background Total nucleated cell (TNC) count and differential are used to classify joint effusions as inflammatory or noninflammatory. Further diagnostic evaluation and management is contingent on this classification. TNC count can be measured by automated analyzers or by manual assessment using a hemocytometer. Studies have raised concerns regarding the accuracy of TNC counts measured by automated instruments, particularly in the setting of joint arthroplasty. The objective of this study was to determine whether metallosis, a complication of total hip arthroplasty in which metal debris accumulates in periprosthetic tissues and synovial fluid, is associated with inaccurate TNC counts in synovial fluid. Methods We compared the accuracy of cell counts measured by the Sysmex XN-1000 and Beckman Coulter Iris iQ200 with the gold standard of manual assessment using a hemocytometer in synovial fluid from patients with suspected metallosis and in fluid obtained from controls from patients with native joints and a history of arthroplasty for other indications. Results TNC counts produced by automated analyzers were associated with increased levels of discordance (relative to manual counts) in patients with metallosis. Metallosis was not associated with increased levels of discordance for RBC counts or WBC differentials. The Sysmex XN flagged all but 1 metallosis sample for manual verification of the results. Conclusions Automated methods are generally reliable for analysis of synovial fluid. TNC counts can be inaccurate in the context of metallosis following total hip arthroplasty. Laboratories should correlate automated cell counts with a microscopic assessment of the specimen, as recommended by instrument manufacturers.

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Comparison of Polyethylene Wear between Highly Crosslinked and Annealed UHMWPE and Conventional UHMWPE against Ceramic Heads in Total Hip Arthroplasty

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.529-530.279 ◽

2012 ◽

Vol 529-530 ◽

pp. 279-284 ◽

Cited By ~ 1

Author(s):

Taishi Sato ◽

Yasuharu Nakashima ◽

Mio Akiyama ◽

Takuaki Yamamoto ◽

Taro Mawatari ◽

...

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Polyethylene Wear ◽

Wear Rates ◽

Head Penetration ◽

Total Hip ◽

Patient Demographics ◽

Ceramic Femoral Head ◽

Implantation Period

The purpose of this study was to examine the effects of ceramic femoral head material on the wear of annealed, crosslinked ultra-high molecular weight polyethylene (UHMWPE) (XLPE) in total hip arthroplasty compared to non-crosslinked conventional UHMWPE (CPE). XLPE was fabricated by crosslinking with 60 kGy irradiation and annealing. Femoral heads made from zirconia and alumina ceramics, and cobalt-chrome (CoCr) of 22 mm or 26 mm diameter were used. In this study, the femoral head penetration into the cup was measured digitally on radiographs of 70 hips with XLPE and 50 hips with CPE. The average follow-up periods were 6.1 and 12.7 years, respectively. The steady wear rate of XLPE was significantly lower than those of CPE (0.002 versus 0.08 mm/year, respectively). Zirconia displayed increased wear rates compared to alumina in CPE; however, there was no difference among head materials in XLPE (0.0028, 0.011 and 0.009 mm/year for zirconia, alumina and CoCr, respectively). Neither head size or implantation period impacted XLPE wear. In contrast to CPE, XLPE displayed low wear rates surpassing the effects of varying femoral head material, size, implantation period and patient demographics.

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