“Asymptomatic” Pseudotumors After Metal-on-Metal Hip Resurfacing Arthroplasty

Kwon, Young‐Min; Ostlere, S; McLardy-Smith, P.; Athanasou, Nicholas A.; Gill, H. S.; Murray, David

doi:10.1016/j.arth.2010.05.030

Cited by 337 publications

(280 citation statements)

References 37 publications

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“…Several recent studies suggest ALTR can occur in asymptomatic, well-functioning MOM hip arthroplasties [15,22,34] and that its prevalence is similar in patients who are asymptomatic and patients with painful MOM hip implants [10]. These studies used either ultrasonography or metal artifact reduction sequence (MARS) MRI to detect ALTR but did not find objective differences in the MRI characteristics between well-functioning and failing hips.…”

Section: Introductionmentioning

confidence: 99%

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Nawabi

Gold

Lyman

et al. 2013

Clin Orthop Relat Res

121

131

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Background Adverse local tissue reactions (ALTR) around metal-on-metal (MOM) hip arthroplasties are increasingly being recognized as a cause of failure. These reactions may be associated with intraoperative tissue damage and complication rates as high as 50% after revision. Although MRI can identify ALTR in MOM hips, it is unclear whether the MRI findings predict those at revision surgery.Questions/purposes We therefore (1) identified which MRI characteristics correlated with histologically confirmed ALTR (using the aseptic lymphocytic vasculitisassociated lesions [ALVAL] score) and intraoperative tissue damage and (2) developed a predictive model using modified MRI to detect ALVAL and quantify intraoperative tissue damage. Methods We retrospectively reviewed 68 patients with failed MOM hip arthroplasties who underwent preoperative MRI and subsequent revision surgery. Images were analyzed to determine synovial volume, osteolysis, and synovial thickness. The ALVAL score was used to grade tissue samples, thus identifying a subset of patients with ALTR. Intraoperative tissue damage was graded using a four-point scale. Random forest analysis determined the sensitivity and specificity of MRI characteristics in detecting ALVAL (score C 5) and intraoperative tissue damage. Results Maximal synovial thicknesses and synovial volumes as determined on MRI correlated with the ALVAL score and were higher in cases of severe intraoperative tissue damage. Our MRI predictive model showed sensitivity and specificity of 94% and 87%, respectively, for detecting ALVAL and 90% and 86%, respectively, for quantifying intraoperative tissue damage.

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Section: Introductionmentioning

confidence: 99%

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Nawabi

Gold

Lyman

et al. 2013

Clin Orthop Relat Res

121

131

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“…In patients with a MOM hip prosthesis, these are thought to be the result of an adverse response to metal wear debris and elevated chromium and cobalt levels [15,35]. Previous studies had only described these masses in symptomatic patients [15,25,26], but a recent study showed during routine followup they were observed in 6.5% of patients with asymptomatic, wellfunctioning, well-positioned prostheses [23].…”

Section: Introductionmentioning

confidence: 99%

Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips

Matthies

Skinner

Osmani

et al. 2012

Clinical Orthopaedics &Amp; Related Research

138

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Background Pseudotumors are sterile inflammatory lesions found in the soft tissues surrounding metal-on-metal (MOM) and metal-on-polyethylene hip arthroplasties. In patients with MOM hip arthroplasties, pseudotumors are thought to represent an adverse reaction to metal wear debris. However, the pathogenesis of these lesions remains unclear. Currently, there is inconsistent evidence regarding the influence of adverse cup position and increased wear in the formation of pseudotumors. Questions/purposes We therefore determined whether pseudotumor formation was associated with (1) adverse cup position, (2) raised metal ion levels, and (3) increased wear rates of the retrieved components. Methods We retrospectively reviewed all 352 patients for whom we had retrieved specimens from revisions of a current-generation MOM hip prosthesis between February 2008 and September 2010; of these, 105 met our inclusion criteria. We used multivariate logistic regression analysis to compare acetabular orientation, metal ion levels before revision, and component wear rates between patients with (n = 72) and without (n = 33) pseudotumors, according to findings on metal artifact reduction sequence MRI. Results The proportion of patients demonstrating evidence of a pseudotumor in well-positioned hips was similar to those with adverse cup positions (67% and 66%, respectively). Patients revised with pseudotumors had similar whole-blood metal ion levels and component wear rates to those who were not revised. Conclusions Pseudotumors were not associated with increased wear or metal ion levels, suggesting patient susceptibility is likely to be more important.

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“…ALVAL has been described in the setting of MOM total hip arthroplasty and MOM hip resurfacing arthroplasty (51)(52)(53) and may manifest as synovitis, bursitis, periprosthetic osteolysis, and cystic or solid masses, which have previously been termed ''pseudotumors'' (53,54).…”

Section: Metal-on-metal-bearing Surfacesmentioning

confidence: 99%

“…The exact prevalence of hypersensitivity reactions following MOM arthroplasties is unknown but in larger retrospective studies ''pseudotumors'' have been reported in up to 1% of patients with MOM hip resurfacing arthroplasty at revision surgery (52,53). The incidence may in fact be higher than this on imaging, as ''pseudotumors'' can occur in asymptomatic patients (53)(54)(55).…”

Section: Metal-on-metal-bearing Surfacesmentioning

confidence: 99%

“…Findings on MRI have included large cystic or solid masses adjacent to the arthroplasty, which histologically have corresponded to ALVAL (52)(53)(54)(55). Preliminary data suggest that a relatively common appearance of ALVAL is expansion of the pseudocapsule with homogenous high signal fluid interspersed with fine ''pepperlike'' intermediate signal intensity foci (Fig.…”

Section: Metal-on-metal-bearing Surfacesmentioning

confidence: 99%

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Magnetic resonance imaging of the postoperative hip

Hayter

Koff

Potter

2012

Magnetic Resonance Imaging

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Magnetic resonance imaging (MRI) is ideally suited to imaging the patient with painful hip arthroplasty due to its superior soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation. MRI is the most accurate imaging modality in the assessment of periprosthetic osteolysis and wear‐induced synovitis, and can also assess regional tendons and neurovascular structures. This article discusses the technical aspects of MRI around metallic implants as well as the appearance of potential complications following hip arthroplasty, including osteolysis, wear‐induced synovitis, infection, hemarthrosis, fracture, loosening, component displacement, heterotopic ossification, tendinopathy, and neurovascular impingement. The specific complication of metal hypersensitivity following metal‐on‐metal prostheses is reviewed. J. Magn. Reson. Imaging 2012;35:1013‐1025. © 2012 Wiley Periodicals, Inc.

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“Asymptomatic” Pseudotumors After Metal-on-Metal Hip Resurfacing Arthroplasty

Cited by 337 publications

References 37 publications

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Pseudotumors Are Common in Well-positioned Low-wearing Metal-on-Metal Hips

Magnetic resonance imaging of the postoperative hip

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