Grading the severity of soft tissue changes associated with metal-on-metal hip replacements: reliability of an MR grading system

Anderson, Helén; Toms, Andoni P.; Cahir, John; Goodwin, Richard; Wimhurst, J.A.; Nolan, John

doi:10.1007/s00256-010-1000-7

Cited by 121 publications

(114 citation statements)

References 21 publications

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“…The severity was classified using the grading system of Anderson et al [2,22]. MRI assessment was performed by one of the authors (RM) with 2 years of experience and was validated by a musculoskeletal radiologist (HP) with more than 10 years of experience reading metal artifact reduction sequence protocol MR images.…”

Section: Participants/study Subjectsmentioning

confidence: 99%

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

Donahue

Lindgren

Galea

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Female patients undergoing hip resurfacing arthroplasties may be at greater risk of revision surgery than males, but it is unclear whether this is related to sex or other factors. We focused our analysis on data from a prospective multicenter cohort study monitoring the ASR TM hip resurfacing arthroplasty prosthesis on the potential association of sex on patient-reported outcome measures (PROMs), metal ion levels, revision surgery, and presence of adverse local tissue reaction. As thousands of patients with the ASR TM prosthesis are still undergoing followup it is critical to optimize the protocol for monitoring these patients.Questions/purposes We wished (1) to assess the associations between sex and implant survival, and adverse local tissue reaction; and (2) to report the differences between sexes in metal ion levels and patient-reported outcome measures. Methods One thousand two hundred fifty-two patients (1390 hips) who underwent hip resurfacing arthroplasty with implantation of the ASR TM prosthesis from April 2003 to July 2010 were eligible for enrollment in a multicenter followup study of the ASR TM Hip Resurfacing System after the voluntary recall of this device was initiated by DePuy in 2010. Nine hundred seventy patients (1098 hips) were enrolled at a mean of 7 years after surgery, with a mean followup of 2 years (range, 1-3.5 years). One of the authors (OM), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, from Zimmer Inc, Biomet, Corin (Cirencester, UK), Iconacy (Warsaw, IN, USA), Renovis (Redlands, CA, USA), Conformis (Burlington, MA, USA), Aston Medical (Saint-É tienne, France), Meril Healthcare (Vapi, Gujarat, India), Arthex (Naples, FL, USA), Mako Surgical Corp, Cambridge Polymer Group (Boston, MA, USA), and Orthopedic Technology Group (Boston, MA, USA). One of the authors (HM), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, from Zimmer Inc, Biomet, Corin, and RSA Biomedical (Umeå, Sweden Nine hundred fifty-eight patients (1084 hips) met the inclusion criteria: ability to provide informed consent, complete PROMs, and continued routine followup. A subset of patients (150 patients, 171 hips), who all were from one center, with annual metal artifact reduction sequence MRI were analyzed. Ninety-three percent of patients from this center had routine MRI performed. The EuroQoL (EQ-5D), Harris hip score (HHS), University of California Los Angeles (UCLA) activity score, VAS pain, radiographs, patient and surgery details, and blood cobalt and chromium levels were obtained. Cox regression analysis was conducted to identify factors associated with implant survival, using any revision as the end point, and presence of adverse local tissue reaction. Results In patients who had unilateral surgery, the only variable found to be associated with revision surgery was HHS (hazard ratio [HR], 0.96; 95% CI, 0.9...

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Section: Participants/study Subjectsmentioning

confidence: 99%

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

Donahue

Lindgren

Galea

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…However, when MRI is performed near a metal implant, artifacts arise, including signal loss and spatially varying displacement in both slice and in-plane directions. MRI methods tailored for metal artifact reduction have also become increasingly popular for the detection of pseudotumors [1,14]. A number of different metal artifact reduction MRI approaches are available with different tradeoffs between scan time and artifact reduction.…”

Section: Introductionmentioning

confidence: 99%

The John Charnley Award: Diagnostic Accuracy of MRI Versus Ultrasound for Detecting Pseudotumors in Asymptomatic Metal-on-Metal THA

Garbuz

Hargreaves

Duncan

et al. 2013

Clin Orthop Relat Res

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Background The prevalence of pseudotumors in patients with large-head metal-on-metal (MOM) THA has been the subject of implant recalls and warnings from various regulatory agencies. To date, there is no consensus on whether ultrasound or MRI is superior for the detection of pseudotumors. Questions/purposes We prospectively compared ultrasound to MRI for pseudotumor detection in an asymptomatic cohort of patients with MOM THAs. We also compared ultrasound to MRI for assessment of pseudotumor growth and progressive soft tissue involvement at a 6-month interval. Methods We enrolled 40 patients with large-head MOM THAs in the study. The mean age was 54 years (range, 34-76 years). The mean time from surgery was 54 months (range, 40-81 months). There were 28 men and 12 women. All patients underwent ultrasound and MRI using slice encoding for metal artifact correction. The gold standard was defined as follows: if both ultrasound and MRI agreed, this was interpreted as concordant and the result was considered accurate. (Toronto, Ontario, Canada). The institution of one or more of the authors (BAH) has received, during the study period, funding from GE Healthcare (Waukesha, WI, USA) and the NIH (Bethesda, MD, USA). One of the authors (DSG) certifies that he or she has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Zimmer, Inc. One of the authors (CPD) certifies that he or she has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Zimmer, Inc, and an amount of USD 10,000 to USD 100,000 from DePuy Synthes Canada Ltd. One of the authors (BAM) certifies that he or she has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Zimmer, Inc. The remaining authors (BAH, DFW, BBF) certify that they have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that the human protocol for this investigation was approved by the appropriate ethics committee at his or her institution, that all investigations were conducted in conformity with the ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the Departments of Orthopaedics and Radiology, University of British Columbia (Vancouver, British Columbia, Canada) and at Vancouver General Hospital (Vancouver, British Columbia...

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“…Severe ALTRs (C3) include fluid-filled cavities extending through deep fascia, tendon avulsion, intermediate T1-weighted soft tissue cortical or marrow signal or fracture. The classification system was originally devised to correspond with the decision and urgency to treat such that C1 meant no immediate intervention but followup was recommended; C2 implied that an elective revision of the hip should be considered; and C3 meant an urgent need for revision surgery [1]. In addition to the Anderson ALTR grading system, synovial thickness and maximal diameter of ALTRs were also determined [10,22].…”

Section: Methodsmentioning

confidence: 99%

“…ALTRs were classified as anterior or posterior based on location relative to the axis of the femoral neck in the axial MRI plane. ALTRs were also classified according to the Anderson ALTR grading system, which has the highest intra-and interobserver reliability of currently used systems [1,28]. Per this classification, a mild ALTR (C1) is defined as a periprosthetic soft tissue mass with no hyperintense T2-weighted fluid signal or a fluid-filled periprosthetic cavity less than 5 cm maximal diameter.…”

Section: Methodsmentioning

confidence: 99%

Early Lessons From a Worldwide, Multicenter, Followup Study of the Recalled Articular Surface Replacement Hip System

Madanat

Hussey

Donahue

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Adverse local tissue reactions (ALTRs) around hip arthroplasties are an important reason for failure of metal-on-metal (MoM) hip implants. Little is known about capsular dehiscence patterns as ALTRs decompress from the hip into the surrounding tissue planes; these patterns may also influence the onset and severity of patient symptoms. Questions/purposes Through a multicenter study approach, we asked: (1) Is ALTR location related to the surgical approach used for arthroplasty in patients who underwent hip arthroplasty (resurfacing or THA) with a single, recalled hip arthroplasty system? (2) Do ALTR severity and location affect patient-reported outcomes in these patients? (3) The institution of one of the authors (HGP) has received, during the study period, funding from GE Healthcare (Waukesha, WI, USA). One of the authors (CB), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Zimmer Inc. One of the authors (OM), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Corin (Cirencester, UK), Iconacy (Warsaw, IN, USA), Renovis (Redlands, CA, USA), Conformis (Burlington, MA, USA), Aston Medical (Saint-É tienne, France), Meril Healthcare (Vapi, Gujarat, India), Arthex (Naples, FL, USA), Orthopaedic Technology Group (Boston, MA, USA); USD 10,000 to USD 100,000, from Mako Surgical Corp; USD 100,000 to USD 1,000,000 from Zimmer Inc; and more than USD 1,000,000 from Biomet and Cambridge Polymer Group (Boston, MA, USA). One of the authors (HM), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, from Zimmer Inc, Biomet, Corin, and RSA Biomedical (Umeå, Sweden). Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® 288 patients (333 hips) from two centers had a metal artifact reduction sequence MRI of the hip performed at a mean time of 6 years postsurgery. Procedures included 166 hips (50%) with ASR resurfacing and 167 hips (50%) with ASR XL THA performed between 2004 and 2010. One hundred twenty-nine hips (39%) had been operated on using a direct lateral approach and 204 using a posterior approach (61%). The EQ-5D, Harris hip score, UCLA activity score, and visual analog scale pain score were obtained for each patient. ALTRs were classified using the Anderson ALTR grading system, and the location, synovial thickness, and diameter of the ATLRs were assessed. The relationship between ALTR location and surgical approach as well as for ALTR severity and patient-reported outcomes were evaluated, and logistic regression was used to identify predictors for moderate-to-severe ALTRs. Results Moderate or severe ALTRs were identified in 79 hips (24%); 41 of these hips had been operated on using the direct lateral approach and 38 using the posterior approach. In patients...

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Grading the severity of soft tissue changes associated with metal-on-metal hip replacements: reliability of an MR grading system

Abstract: The grading system described in this study is reliable for evaluating ALVAL in MoM prostheses using MR but is limited in differentiating mild disease from infection.

Cited by 121 publications

References 21 publications

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

The John Charnley Award: Diagnostic Accuracy of MRI Versus Ultrasound for Detecting Pseudotumors in Asymptomatic Metal-on-Metal THA

Early Lessons From a Worldwide, Multicenter, Followup Study of the Recalled Articular Surface Replacement Hip System

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