Comparison of Asymptomatic and Symptomatic Adverse Local Tissue Reaction in Patients With Head-Neck Taper Corrosion

Weber, Margaret A.; Snyder, Matthew; Workman, Kalain K.; Sims, Margaret M.; Smith, Clair; Kumar, Deepak; Daji, Akshay V.; Borrero, Camilo; Cordle, Andrew C.; DiGioia, Anthony M.; Hamlin, Brian R.; Plakseychuk, Anton; Urish, Kenneth L.

doi:10.1016/j.arth.2020.09.014

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…Advanced MARS techniques such as VAT and SEMAC have been proven to reliably detect and classify ARMD in the context of metal-on-metal hip prostheses 11,116–128 . The relevance and importance of MARS-MRI in case of ARMD are further stressed by various studies, which describe a high prevalence of metal-induced local tissue reactions also in patients before they become symptomatic and the unreliability of laboratory findings (ie, serum metal ion levels) to identify patients with complications who may benefit from revision surgery 124,128–131 . Metal artifact reduction sequence MRI has also been shown to be more accurate than radiography 132,133 and, for smaller lytic zones (<3 cm), also more accurate than CT in evaluation of periprosthetic osteolysis, even without the use of multispectral imaging 134 …”

Section: Basic Methodsmentioning

confidence: 99%

“…11,[116][117][118][119][120][121][122][123][124][125][126][127][128] The relevance and importance of MARS-MRI in case of ARMD are further stressed by various studies, which describe a high prevalence of metal-induced local tissue reactions also in patients before they become symptomatic and the unreliability of laboratory findings (ie, serum metal ion levels) to identify patients with complications who may benefit from revision surgery. 124,[128][129][130][131] Metal artifact reduction sequence MRI has also been shown to be more accurate than radiography 132,133 and, for smaller lytic zones (<3 cm), also more accurate than CT in evaluation of periprosthetic osteolysis, even without the use of multispectral imaging. 134 Other findings that can be assessed by MARS-MRI are radiographically occult periprosthetic fractures, hemarthrosis, capsular thickening and adhesions, heterotopic ossification, iliopsoas impingement, bursitis, and tendon injuries.…”

Section: Hipmentioning

confidence: 99%

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Magnetic Resonance Imaging Around Metal at 1.5 Tesla

2021

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During the last decade, metal artifact reduction in magnetic resonance imaging (MRI) has been an area of intensive research and substantial improvement. The demand for an excellent diagnostic MRI scan quality of tissues around metal implants is closely linked to the steadily increasing number of joint arthroplasty (especially knee and hip arthroplasties) and spinal stabilization procedures. Its unmatched soft tissue contrast and cross-sectional nature make MRI a valuable tool in early detection of frequently encountered postoperative complications, such as periprosthetic infection, material wear–induced synovitis, osteolysis, or damage of the soft tissues. However, metal-induced artifacts remain a constant challenge. Successful artifact reduction plays an important role in the diagnostic workup of patients with painful/dysfunctional arthroplasties and helps to improve patient outcome. The artifact severity depends both on the implant and the acquisition technique. The implant's material, in particular its magnetic susceptibility and electrical conductivity, its size, geometry, and orientation in the MRI magnet are critical. On the acquisition side, the magnetic field strength, the employed imaging pulse sequence, and several acquisition parameters can be optimized. As a rule of thumb, the choice of a 1.5-T over a 3.0-T magnet, a fast spin-echo sequence over a spin-echo or gradient-echo sequence, a high receive bandwidth, a small voxel size, and short tau inversion recovery–based fat suppression can mitigate the impact of metal artifacts on diagnostic image quality. However, successful imaging of large orthopedic implants (eg, arthroplasties) often requires further optimized artifact reduction methods, such as slice encoding for metal artifact correction or multiacquisition variable–resonance image combination. With these tools, MRI at 1.5 T is now widely considered the modality of choice for the clinical evaluation of patients with metal implants.

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Section: Basic Methodsmentioning

confidence: 99%

Section: Hipmentioning

confidence: 99%

Magnetic Resonance Imaging Around Metal at 1.5 Tesla

2021

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“…ALTR may occur with any type of bearing, even with ceramic-on-polyethylene. 1,45 Furthermore, not all patients with ALTR are symptomatic, 46 but crevice corrosion in V40 tapers seems to be of particular clinical relevance, as an increasing number of patients with substantial taper corrosion and gross failure have been reported. 17,18,20,21 Therefore, we feel that patients with these components should be regularly screened for ALTR.…”

Section: Discussionmentioning

confidence: 99%

The incidence of adverse local tissue reaction due to head taper corrosion after total hip arthroplasty using V40 taper and 36 mm CoCr head

Grothe

Günther

Hartmann

et al. 2022

The Bone & Joint Journal

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Aims Head-taper corrosion is a cause of failure in total hip arthroplasty (THA). Recent reports have described an increasing number of V40 taper failures with adverse local tissue reaction (ALTR). However, the real incidence of V40 taper damage and its cause remain unknown. The aim of this study was to evaluate the long-term incidence of ALTR in a consecutive series of THAs using a V40 taper and identify potentially related factors. Methods Between January 2006 and June 2007, a total of 121 patients underwent THA using either an uncemented (Accolade I, made of Ti12Mo6Zr2Fe; Stryker, USA) or a cemented (ABG II, made of cobalt-chrome-molybdenum (CoCrMo); Stryker) femoral component, both with a V40 taper (Stryker). Uncemented acetabular components (Trident; Stryker) with crosslinked polyethylene liners and CoCr femoral heads of 36 mm diameter were used in all patients. At a mean folllow-up of 10.8 years (SD 1.1), 94 patients (79%) were eligible for follow-up (six patients had already undergone a revision, 15 had died, and six were lost to follow-up). A total of 85 THAs in 80 patients (mean age 61 years (24 to 75); 47 (56%) were female) underwent clinical and radiological evaluation, including the measurement of whole blood levels of cobalt and chrome. Metal artifact reduction sequence MRI scans of the hip were performed in 71 patients. Results A total of 20 ALTRs were identified on MRI, with an incidence of 26%. Patients with ALTR had significantly higher median Co levels compared with those without ALTR (2.96 μg/l (interquartile range (IQR) 1.35 to 4.98) vs 1.44 μg/l (IQR 0.79 to 2.5); p = 0.019). Radiological evidence of osteolysis was also significantly associated with ALTR (p = 0.014). Median Cr levels were not significantly higher in those with ALTR compared with those without one (0.97 μg/l (IQR 0.72 to 1.9) v 0.67 μg/l (IQR 0.5 to 1.19; p = 0.080). BMI, sex, age, type of femoral component, head length, the inclination of the acetabular component, and heterotopic ossification formation showed no significant relationship with ALTR. Conclusion Due to the high incidence of local ALTR in our cohort after more than ten years postoperatively, we recommend regular follow-up investigation even in asymptomatic patients with V40 taper and metal heads. As cobalt levels correlate with ALTR occurrence, routine metal ion screening and consecutive MRI investigation upon elevation could be discussed. Cite this article: Bone Joint J 2022;104-B(7):852–858.

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“…In a meta-analysis, Wiley et al reported a 0.6% estimated incidence of pseudotumor after MoM THA or resurfacing arthroplasty [12]. Higher prevalence has been reported in asymptomatic patients and after prolonged follow-up, suggesting growth of pseudotumors over time [13][14][15][16]. The rate of revision THA due to symptomatic pseudotumor has been reported to be 0.5% in non-MoM THAs and 2-to 3-fold higher in MoM THA [6,7,12,16,17].…”

Section: Discussionmentioning

confidence: 99%

Intrapelvic Pseudotumor Causing Neuropathy and Vascular Obstruction After Revision Total Hip Arthroplasty: A Case Report

et al. 2021

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Background: There is a growing body of recent literature regarding the occurrence of pseudotumors associated with modular junctions and various bearing surfaces after total hip arthroplasty (THA). Revision surgery is often technically challenging and high complication rates have been reported. The optimal management of these patients and outcomes after operative treatment remain poorly understood. Methods: We report the case of a 77-year-old male with progressive unilateral lower extremity swelling, pain, and neuropathy 9 years after revision THA for polyethylene liner wear. Imaging and biopsy confirmed a massive intrapelvic pseudotumor exerting compressive effects. Radiographs demonstrated extensive femoral and pelvic osteolysis without evidence of component loosening. Debulking of the intrapelvic portion of the pseudotumor was performed via the lateral window of the ilioinguinal approach with component retention. Results: Debulking of the intrapelvic mass resulted in resolution of symptoms. One year postoperatively the patient reported pain free ambulation using a walker and no recurrence of symptoms. Radiographs demonstrated stable THA components in comparison with preoperative films. Discussion and Conclusion: This case demonstrates a rare finding of intrapelvic pseudotumor causing neurovascular compression after revision THA. Clinicians should be aware of intrapelvic pseudotumor as a possible cause of limb swelling and neuropathy, and that debulking of the mass is a potential treatment option in the setting of well-fixed implants.

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Comparison of Asymptomatic and Symptomatic Adverse Local Tissue Reaction in Patients With Head-Neck Taper Corrosion

Cited by 6 publications

References 21 publications

Magnetic Resonance Imaging Around Metal at 1.5 Tesla

Magnetic Resonance Imaging Around Metal at 1.5 Tesla

The incidence of adverse local tissue reaction due to head taper corrosion after total hip arthroplasty using V40 taper and 36 mm CoCr head

Intrapelvic Pseudotumor Causing Neuropathy and Vascular Obstruction After Revision Total Hip Arthroplasty: A Case Report

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