Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

Abstract

Background Little is known about intraarticular pathology following THA prior to the radiographic appearance of osteolysis, primarily due to imaging limitations. MRI has recently been applied to imaging the postarthroplasty hip with the ability to detect periarticular bony and soft tissue pathology; specifically, it is able to detect abnormal synovial patterns and focal bone loss well before the radiographic appearance of osteolysis. Questions/purposes We therefore used MRI to determine the incidence of early reactive synovitis and osteolysis in asymptomatic patients after THA, and whether there is an association between these MRI findings and clinical outcomes or radiographic wear measurements at this early stage. Methods We recruited 31 patients (33 hips) who underwent routine noncemented THA with one of three types of bearing surfaces: metal-on-cross-linked polyethylene (n = 7), ceramic-on-ceramic (n = 12), and ceramic-on-cross-linked polyethylene (n = 14). Patients underwent specialized MRI at a minimum of 12 months (mean, 23 months; range, 12-37 months) after surgery. MR images were analyzed for the presence of synovitis or osteolysis. WOMAC scores, patient assessment questionnaires, and radiographic wear measurements were correlated with MRI findings. Results Reactive synovitis was observed in 13 of 33 patients (39%) and focal osteolysis in one of 33 (3%). The presence of synovitis did not correlate with pain, activity level, patient satisfaction or clinical outcome scales, nor did it correlate with radiographic wear measurements at early followup. Conclusions Our observations suggest reactive synovitis is common yet asymptomatic at short-term followup. We do not know either the etiology or the long-term implications of these observations.

Surface wet-ability modification of thin PECVD silicon nitride layers by 40 keV argon ion treatments

“…This angle is lower than 90°also after the ion bombardment, so the silicon nitride surface remains hydrophilic, according to Cooper et al (2010).…”

“…Because the substrate of a material which must be implanted in the human body is not a passive anchoring surface but is able to stimulate the adhesion and cell proliferation, it is important to know both its hydrophilicity that its surface roughness in order to increase the ability of cell migration. A large number of studies indicate that cells tend to fixate on hydrophilic surfaces than on hydrophobic ones; that the diffusion and the formation of the continuous layer of cells are higher on a rough surface than on a smooth one (Cooper et al, 2010).…”

Metal Artifact Reduction Sequence MRI Abnormalities Occur in Metal-on-polyethylene Hips

“…MRI has become the leading imaging modality in the evaluation of ALTRs after THA as a result of its accuracy in identifying soft tissue abnormalities [11,19]. In one study, early intraarticular synovitis was identified on MARS MRI in nine of 21 asymptomatic metal-on-plastic or ceramic-on-plastic patients [3]. The significance of this intraarticular synovial reaction remains unknown and stands in contrast to the extraarticular lesions with joint communication seen in our series of patients with MRI abnormalities after MoP hips.…”

A painful soft tissue mass secondary to impingement of a metal on polyethylene bearing total hip arthroplasty

“…The overall incidence and any causal relationships have, therefore, not previously been described. Patients with this bearing surface do not usually present with painful symptoms until macrophage-driven osteolysis has significantly affected the bone surrounding the implants 25. Patients tend to present with symptoms of instability or overt dislocation if component malposition leads to impingement within a physiological range of motion.…”