(b) Image shows chronic high-grade partial stripping of the gluteus medius tendons (arrow) near the insertion. 1, Journal of Clinical Imaging Science, Vol. Polyethylene Wear–induced Synovitis.—Wear of acetabular polyethylene liners in metal-on-polyethylene and ceramic-on-polyethylene implants is a primary cause of arthroplasty implant failure with time and is perhaps the best understood and most predictable type of arthroplasty component wear (44). Complications of total hip arthroplasty are common and it is essential for the radiologist to be aware of them in the assessment of radiographs of total hip replacements. If the address matches an existing account you will receive an email with instructions to reset your password. Figure 15d Spectrum of adverse local tissue reactions caused by hypersensitivity to metal products. The sciatic, femoral, and obturator nerves are well demonstrated on axial MR images. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Occasionally, decompression of synovitis forms large tumorlike extraarticular deposits, which can resemble the pseudotumors described in adverse local tissue reactions to metal debris (described in the next section). 2. Table 2: Pulse Sequence Protocol for MR Imaging of Hip Arthroplasty Implants. MR imaging findings of adverse local tissue reaction and histologically diagnosed ALVAL range from expansion of the pseudocapsule with homogeneous high-signal-intensity fluid and a relatively thin synovial wall lining to various amounts of solid synovial proliferations and debris resembling pseudotumors (Fig 15). Nonspecific Mechanical Irritation of Synovium.—The normal pseudocapsule should be thin, low signal intensity, continuous, and closely applied to the neck of the implant (Fig 11). Objective To evaluate the efficacy and safety of hip replacement and intramedullary nails for treating unstable intertrochanteric fractures in elderly patients. MR images of the pelvis with a large field of view (FOV) can be acquired with the body coil or multichannel surface body coil systems. Figure 15c Spectrum of adverse local tissue reactions caused by hypersensitivity to metal products. 5, The Journal of Bone and Joint Surgery, Vol. Moderate echo times preserve the signal-to-noise and contrast-to-noise ratios and result in fluid-sensitive but not T2-weighted MR images. Coronal intermediate-weighted MAVRIC MR image (4400/32) of a metal-on-metal hip arthroplasty system shows an acetabular component fixation screw (arrow) that impinges on the iliopsoas muscle-tendon junction. Given the large number of structures that need to be assessed in patients with hip arthroplasty implants, a structured approach to image interpretation and reporting is suggeste… 97, No. Taljanovic MS, Jones MD, Hunter TB et-al. As with any operation, hip replacement surgery has risks as well as benefits. Additionally, some physicians and imaging sites may still question the safety of scanning patients with indwelling metal implants. The condition is often associated with severe hip degeneration, which can be treated successfully with arthroplasty (82). Aseptic or mechanical implant loosening describes the complete loss of fixation of an implant. Keogh CF, Munk PL, Gee R et-al. Note the encasement of the thickened and laterally displaced femoral nerve (arrowhead). Because its signal intensity is similar to that of adjacent muscle, decompression of highly particulate synovitis may be difficult to detect, necessitating careful assessment of the soft tissues in the presence of pseudocapsular distention (Fig 13). The patellar complications that we observed following total knee arthroplasty include insta‐ bility/dislocation, fracture, osteonecrosis, infection, erosion, impingement on the prosthesis, patellar or quadriceps tendon tear, and loosening or rupture of the patellar prosthetic but‐ ton. The demonstration of a linear hypointense signal alteration of the cortex distinguishes a periprosthetic fracture from a stress reaction (13,14) (Fig 3). Posteriorly, the sciatic nerve and its relationship to the piriformis muscle and pseudocapsule are demonstrated. The patient underwent total hip arthroplasty without complication and recovered excellent function after rehabilitation. 1994;162 (6): 1387-91. 4. 46, No. MR imaging is the most useful imaging modality to assess the severity of intracapsular polyethylene wear–induced synovitis (13,14). 1, 24 November 2015 | Magnetic Resonance in Medicine, Vol. Similarly, an intact interface of a cemented component is characterized by intimate contact between the host bone and the cement. A small volume of joint fluid (arrows in b) is tracking into the greater trochanteric bursa through a small defect of the posterior capsule. (a) Coronal intermediate-weighted fast SE MR image (4002/31 [repetition time msec/echo time msec]) shows a solid adverse local tissue reaction (arrow) near the greater trochanteric bursa. Complications ranging from osteolysis caused by granulomatous reaction to particulate wear debris lead to many long-term failures. The iliopsoas tendon may be partially obscured by susceptibility artifact as the tendon courses over the iliopectineal eminence and is occasionally seen to better advantage on coronal and sagittal MR images. Figure 17a Adverse local tissue reaction to metal products with sciatic nerve compromise in a 74-year-old woman. Figure 6b Periprosthetic bone resorption in a 52-year-old man. The wide FOV also helps depict sacral and pubic stress fractures, as well as marrow infiltration and metastatic disease. Regional muscles and tendons were assessed for tendinosis, tear, atrophy, and edema. Note the excessive acetabular anteversion (dotted line), which measured 48°, a finding that represents a risk factor for anterior instability. 56, No. 23, No. Additionally, axial MR images demonstrate the integrity of the anterior and posterior pseudocapsule, synovitis, and distention of the iliopsoas, subiliac, and trochanteric bursae. Marked distention of bursae around the hip may also displace or compress the sciatic and femoral nerves. Several types of implant-related wear contribute to the presence of metal products in synovial fluid and periprosthetic soft tissues, a finding that occurs to varying degrees in both well-positioned and malpositioned hip arthroplasty components. (b) Axial intermediate-weighted fast SE MR image (4100/22) shows cortical hypointensity and periosteal new bone formation (arrow). Figure 20 Coexisting hypersensitivity and metallosis in a 62-year-old woman. However, the presence of a polyethylene liner, a longer time course of the implant, and accurate interpretation of the pattern of synovitis help to distinguish these pathologically and histologically distinct entities. Figure 7b Integrity of the posterior pseudocapsule and short external rotators in two patients. 47, No. Associated polyethylene wear–induced osteolysis is typically bulky, with particulate debris replacing the normal periprosthetic trabecular bone and marrow signal intensity (Fig 14). Radiographs are insensitive for the detection of implant infection because periosteal reaction and osteolysis are nonspecific late findings and may also occur with mechanical loosening and wear-induced synovitis. In recurrent hemarthrosis, MR imaging shows thickening of the synovium, with hemorrhagic debris of mixed signal intensity in the joint capsule or trochanteric bursa (16). Implant Wear Symposium 2007 Clinical Work Group. Figure 5a Limited osseous integration in a 63-year-old man. Higher amplitude or steeper gradients result in shorter interecho spacing, thus permitting an increase in the echo train length per repetition time at the same effective echo time, which allows for overall faster imaging time. (b) Axial intermediate-weighted fast SE MR image (4051/27) shows circumferential bone resorption around a femoral implant. But possible complications include the following. The iliopsoas tendon is depicted as it courses over the iliopectineal eminence and can be traced to its insertion. Risks associated with Magnetic Resonance Imaging (MRI) of patients with hip and knee implants This document was updated on May 2020. (d) MR image (4850/27) of a 73-year-old woman shows expansion of the pseudocapsule with solid material (arrow), a finding that resembles a pseudotumor. Figure 16 Adverse local tissue reaction caused by hypersensitivity to metal products, with extensive soft-tissue necrosis, in a 48-year-old man. At MR imaging, intact nerves demonstrate preservation of the perineural fat plane, an internal fascicular pattern, and intermediate signal intensity. Axial intermediate-weighted fast SE MR image (5733/26) shows a dislodged polyethylene liner (arrow) situated between the left gluteus maximus and gluteus medius muscles. Then various complications and their MR imaging appearances are detailed, including periprosthetic fracture and stress reaction, osseous integration and aseptic loosening, instability and dislocation, hematoma, synovitis, adverse local tissue reaction, infection, tendon-related complications, heterotopic ossification, nerve-related complications, neoplasm, and other complications. At MR imaging, the intact periprosthetic cortex and periosteum demonstrate hypointense signal intensity with STIR and intermediate-weighted fast SE sequences. The spectrum of tendon abnormalities ranges from tendinosis to partial-thickness tears and frank tendon rupture (Fig 23). Current research suggests that the failure rate in the U.S. hovers around one percent per year, a strikingly low number. Disruption of the pseudocapsule is commonly depicted and usually occurs at the posterolateral attachment, allowing fluid and debris to decompress into the greater trochanteric bursa, where the adverse local tissue reaction can then contact the abductor tendon insertions (Fig 16). and H.G.P. The size, location, and extent of the hematoma are important factors to predict the risk for wound dehiscence and infection of a postoperative hematoma. 1. The MRI examinations of patients with metal-on-metal hip prostheses placed at resurfacing arthroplasty (n= 31) or THA (n= 29) were reviewed for osteolysis, synovitis, extracapsular disease, synovial pattern, and mode of decompression into adjacent bursae. 7. Figure 2a Periprosthetic stress reaction of the femur in a 63-year-old man. (a) Coronal inversion-recovery MAVRIC MR image (3975/36) of a metal-on-metal hip arthroplasty system shows a bone marrow edema pattern, periosteal new bone formation, and adjacent soft-tissue edema (arrow) along the medial margin of the proximal portion of the femur. 45, No. 4, 21 August 2015 | RadioGraphics, Vol. Serial MR imaging may be required to prove or disprove suspected loosening. 39, No. This occurs when the ball of the femoral component is dislocated from the acetabular cup, when the hip is put into an extreme or unusual position. 31 (2): 301. The occurrence of primary bone tumors, soft-tissue neoplasms, and metastases at the site of a hip arthroplasty that was performed for reasons other than tumor resection is rare (80), but when they occur, these findings must be differentiated from those of osteolysis secondary to wear-induced synovitis and immature heterotopic ossification. Although, to our knowledge, no findings have been published from a study to assess osseous implant integration at MR imaging, there are differences in the appearances of complete osseous integration, fibrous membrane formation, bone resorption, and implant loosening. The SEMAC technique uses section selective three-dimensional SE acquisitions for minimization of through-plane distortion, view-angle tilting to minimize in-plane distortion, and optionally high-bandwidth radiofrequency pulses and increased readout bandwidth (22). Axial small-FOV high-spatial-resolution intermediate-weighted fast SE MR imaging should extend from the anterior to the posterior skin surface, transversely from the pubic symphysis to the skin surface, and craniocaudally from above the acetabulum to below the lesser trochanter. Group A included seromas and small hematomas. (b) Lateral radiograph shows early ossification (arrow). MAVRIC MR images are acquired as multiple frequency selective data bins off the resonance frequency of hydrogen, which are then recombined by using a sum of squares algorithm, thereby minimizing in-plane frequency shifts. Traditionally, magnetic resonance imaging (MR) has been felt to have a limited role in the evaluation of the affected hip in patients who have undergone hip arthroplasty, as extensive magnetic susceptibility artifact related to the indwelling hardware resulted in images felt to be non-diagnostic. When there is dehiscence of the posterior pseudocapsule, even small volumes of joint fluid may be seen communicating with the greater trochanteric bursa. (a) Axial intermediate-weighted fast SE MR image (4051/27) of an acetabular component shows bone resorption over the anterior wall and column. Hip resurfacing, a surgical alternative to total hip replacement (THR), involves placing a metal cap over the head of the femur while a matching metal cup, similar to that used in a THR, is placed in the pelvic socket. Figure 23b Iliopsoas impingement and tendon rupture in a 75-year-old woman. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The susceptibility differences cause field inhomogeneity in both the frequency- and section-encoding directions, which results in distortion of regional anatomy and a “pileup” of signal around an area of signal void. At MR imaging, an intact posterior capsule is seen to contact the greater trochanter, whereas a lack of contact indicates capsular dehiscence (37) (Fig 7). MR imaging with optimized conventional pulse sequences and metal artifact reduction techniques is a comprehensive imaging modality for the evaluation of the hip after arthroplasty, contributing important information for diagnosis, prognosis, risk stratification, and surgical planning. A moderate adverse local tissue reaction (C2) was defined as a C1 lesion with a maximum diameter larger than 5 cm or a C1 lesion with either (a) atrophy or edema pattern of a muscle other than the short external rotators or (b) a bone edema pattern. May benefit from a total hip arthroplasty implants by adverse local tissue reaction in a 63-year-old man implant in 63-year-old... Joint aspiration is ultimately required to prove the presence of an adverse local tissue reactions 34.. Articulations, MR imaging also demonstrates the degree of tissue disruption mri hip replacement complications effect... Effects of static field inhomogeneities email address below and we will send you reset. 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