Magnetic resonance imaging in the evaluation of periprosthetic acetabular osteolysis: A cadaveric study

Abstract

Periprosthetic osteolysis is a well recognized complication of total hip arthroplasty that leads to implant failure. The ability to accurately assess and visualize the position and volume of periacetabular bone defects is paramount for clinical observation and medical treatment, as well as pre-operative planning of revision surgery. We have developed a modified magnetic resonance imaging (MRI) protocol that is useful in detection and quantification of periacetabular bone loss. The purpose of this study is to compare MRI to plain film analysis in the assessment of periacetabular bone loss using a cadaver model. MRI was 95% sensitive in the detection of lesions. Specificity was 98%, and accuracy was 96%. Lesion detection was not statistically dependent on lesion location (p = 0.27). The mean absolute error in determining lesion size was 0.8 k 2.2 cm3. There was a correlation between increasing lesion size and lesion detection (p = 0.02, logistic regression). The largest lesion that was missed by MRI analysis measured 2.8 cm3, and all lesions 23.0 cm3 were correctly identified, with a relative error volume measurement of 12.4 f 25.3%. This correlated to an absolute error of 1.4 f 2.4 cm3. Using conventional radiographic analysis, the overall sensitivity of lesion detection was 520/0, and the specificity was 96%. Using plain film analysis, identification of true lesions depended on the location with 83% of ilia1 lesions, 64% of pubic lesions, 55% of ischial lesions, and 0% of posterior wall lesions correctly identified. The modified MRI technique utilized did allow for accurate visualization of simulated osteolytic lesions, and may provide a suitable noninvasive method to provide serial assessment of clinical periacetabular osteolysis without the use of ionizing radiation.

Magnetic resonance imaging of the postoperative hip

“…MRI is the most accurate imaging modality for the assessment of periprosthetic osteolysis and wear-induced synovitis (4)(5)(6). MRI also allows assessment of regional tendons and neurovascular structures, which are a potential cause of pain in a patient with a painful arthroplasty who is being considered for revision surgery.…”

“…CT also has the disadvantage of exposing the patient to ionizing radiation and the techniques required to minimize beam-hardening artifact in the presence of metallic implants even further increase the effective dose to the patient, which can prove a burden in the setting of serial examinations. MRI is superior to conventional radiographs and CT in the assessment of periprosthetic osteolysis and has been shown to be the most sensitive method to quantify the extent of periprosthetic osteolysis (5,6). In a cadaveric model of simulated osteolysis surrounding hip implants, MRI demonstrates a sensitivity of 95%, compared to CT (with high kVp) of 75% and radiographs (including oblique views) of 52%, with similar specificities, thus indicating MRI was the most accurate means by which to detect and quantify periprosthetic bone loss (5).…”

Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

“…In recent years, there have been numerous studies examining its role in imaging THA [3,7,38,39,46,[50][51][52]. MRI is effective for detecting periarticular bony and soft-tissue abnormalities in patients with a postarthroplasty hip [3,39,46,52], as well as determining the source of enigmatic hip following THA [7].…”

“…MRI is effective for detecting periarticular bony and soft-tissue abnormalities in patients with a postarthroplasty hip [3,39,46,52], as well as determining the source of enigmatic hip following THA [7]. Due to its direct multiplanar capabilities and superior soft-tissue contrast, MRI is able to visualize intracapsular synovitis [7,39,52] and is more sensitive in the detection of osteolytic lesions than radiographs or CT [50,51]. Specifically, the ability of optimized MRI to detect wear-induced particle disease in the postarthroplasty hip has been documented in two studies that have corroborated this MRI finding with tissue pathology [39,52].…”

Experimental MR imaging of zirconia ceramic joint implants at 1.5 and 3 T

“…Despite the current success of TKA, postoperative complications such as peri-prosthetic fracture, infection, or loosening due to osteolysis remain. To increase the success rate in revision surgery, which includes determining potential bone graft needs, as well as implant inventory required to achieve a stable and durable reconstruction, accurate description of the proximity of intraosseous and soft tissue deposits to vital anatomical structure is important (1).…”