Magnetic Resonance Imaging Predicts Adverse Local Tissue Reaction Histologic Severity in Modular Neck Total Hip Arthroplasty

Barlow, Brian; Ortiz, Philippe A.; Fields, Kara G.; Burge, Alissa J.; Potter, Hollis G.; Westrich, Geoffrey H.

doi:10.1016/j.arth.2016.03.022

Cited by 11 publications

(23 citation statements)

References 18 publications

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“…Prior acetabular revision surgery in patients with dual taper modular neck stem THA [59], a systematic diagnostic evaluation has to be executed, using specific tests such as serum metal (Co, Cr) ion analysis, plain antero-posterior and lateral radiographs [59,69] and cross-sectional imaging modalities (MARS-MRI, US) [48,55,59,77]. The patient's stated pain level (e.g., VAS pain score) should also be included as an important factor and measurements of IA cobalt and chromium levels may be meaningful [70].…”

Section: Discussionmentioning

confidence: 99%

How to Proceed with Asymptomatic Modular Dual Taper Hip Stems in the Case of Acetabular Revision

Grupp

Baxmann²,

Jansson

et al. 2020

Materials

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How to proceed with a clinically asymptomatic modular Metha® Ti alloy stem with dual taper CoCr neck adapter in case of acetabular revision? To systematically answer this question the status of research and appropriate diagnostic methods in context to clinically symptomatic and asymptomatic dual taper stem-neck couplings has been evaluated based on a systematic literature review. A retrieval analysis of thirteen Metha® modular dual taper CoCr/Ti alloy hip stems has been performed and a rational decision making model as basis for a clinical recommendation was developed. From our observations we propose that in cases of acetabular revision, that for patients with a serum cobalt level of > 4 µg/L and a Co/Cr ratio > 3.6, the revision of the modular dual taper stem may be considered. Prior to acetabular revision surgery a systematic diagnostic evaluation should be executed, using specific tests such as serum metal (Co, Cr) ion analysis, plain antero-posterior and lateral radiographs and cross-sectional imaging modalities (Metal Artefact Reduction Sequence Magnetic Resonance Imaging). For an asymptomatic Metha® dual taper Ti alloy/CoCr stem-neck coupling at the stage of acetabular revision careful clinical decision making according to the proposed model should be followed and overreliance on any single examination should be avoided, considering the complete individual differential diagnosis and patient situation.

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Section: Discussionmentioning

confidence: 99%

How to Proceed with Asymptomatic Modular Dual Taper Hip Stems in the Case of Acetabular Revision

Grupp

Baxmann²,

Jansson

et al. 2020

Materials

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“…Of the five studies evaluating histologic grading, three found an association between mixed or solid features and ALVAL score. 10,11,19 In 11 symptomatic patients revised with MoP THA, Nodzo et al 20 identified mixed patterns of synovitis in all patients. Therefore, they were unable to draw a relationship between synovial composition and intraoperative findings.…”

Section: Resultsmentioning

confidence: 99%

“…Metal artifact reduction MRI was performed in all 15 studies. 5,[9][10][11][12][13][14][15][16][17][18][19][20][21][22] Four studies used the Hauptfleisch grading system for ALTR classification. 9,13,15,16 This defined cystic lesions as either type I with synovial wall thickness ,3 mm or type II with synovial wall thickness .3 mm.…”

Section: Imagingmentioning

confidence: 99%

MRI Characteristics of Adverse Local Tissue Reactions Associated With Intraoperative Tissue Damage and Poor Revision Surgery Outcomes: A Systematic Review

Xiong

Smith

Klemt

et al. 2020

J Am Acad Orthop Surg

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Background: Metal artifact reductions sequence (MARS) MRI has been established as a cross-sectional imaging modality for diagnosis of adverse local tissue reaction (ALTR). This study aims to evaluate the current literature regarding the characteristics of MARS MRI associated with intraoperative tissue necrosis and postoperative complications in patients undergoing revision THA because of ALTR. Methods: We systematically searched the literature that included reporting MRI characteristics of ALTR in failed THA and their correlation with intraoperative findings and postoperative outcomes. Results: A total of 617 studies were assessed, and 15 studies met the inclusion criteria. Synovial wall thickness correlated with increasing ALVAL grade, however, weakly with tissue necrosis. Synovial composition of mixed or solid features and the presence of abductor disruption correlated with complications and tissue necrosis. Tissue edema was a poor predictor of aseptic lymphocyte-dominant vasculitis-associated lesion (ALVAL) grade or tissue necrosis. Discussion: MARS MRI synovial composition including mixed and solid features and the presence of abductor disruption provide the best prognostic characteristics associated with intraoperative soft-tissue necrosis and revision surgery outcome. These prognostic characteristics on MRI may assist surgeons with improved criteria for intervention and preoperative patient counseling.

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“…Indeed, it appears that PET/MRI is better than PET/CT for specifying pain generators, particularly in cases of hip arthroplasties. Successful results from recent MRI studies on painful THA complications [26][27][28][29] suggest MRI has a higher sensitivity for early-stage complications than CT, radiograph, and ultrasound, making MRI better suited for pairing with F 18 -FDG PET versus CT.…”

Section: F 18 -Fdg Pet For Persistent Postsurgical Pain After Total Hmentioning

confidence: 99%

Identifying Musculoskeletal Pain Generators Using Clinical PET

Yoon

Kogan

Gold

et al. 2020

Semin Musculoskelet Radiol

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Identifying the source of a person's pain is a significant clinical challenge because the physical sensation of pain is believed to be subjective and difficult to quantify. The experience of pain is not only modulated by the individual's threshold to painful stimuli but also a product of the person's affective contributions, such as fear, anxiety, and previous experiences. Perhaps then to quantify pain is to examine the degree of nociception and pro-nociceptive inflammation, that is, the extent of cellular, chemical, and molecular changes that occur in pain-generating processes. Measuring changes in the local density of receptors, ion channels, mediators, and inflammatory/immune cells that are involved in the painful phenotype using targeted, highly sensitive, and specific positron emission tomography (PET) radiotracers is therefore a promising approach toward objectively identifying peripheral pain generators. Although several preclinical radiotracer candidates are being developed, a growing number of ongoing clinical PET imaging approaches can measure the degree of target concentration and thus serve as a readout for sites of pain generation. Further, when PET is combined with the spatial and contrast resolution afforded by magnetic resonance imaging, nuclear medicine physicians and radiologists can potentially identify pain drivers with greater accuracy and confidence. Clinical PET imaging approaches with fluorine-18 fluorodeoxyglucose, fluorine-18 sodium fluoride, and sigma-1 receptor PET radioligand and translocator protein radioligands to isolate the source of pain are described here.

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Magnetic Resonance Imaging Predicts Adverse Local Tissue Reaction Histologic Severity in Modular Neck Total Hip Arthroplasty

Cited by 11 publications

References 18 publications

How to Proceed with Asymptomatic Modular Dual Taper Hip Stems in the Case of Acetabular Revision

How to Proceed with Asymptomatic Modular Dual Taper Hip Stems in the Case of Acetabular Revision

MRI Characteristics of Adverse Local Tissue Reactions Associated With Intraoperative Tissue Damage and Poor Revision Surgery Outcomes: A Systematic Review

Identifying Musculoskeletal Pain Generators Using Clinical PET

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