MRI as Diagnostic Modality for Analyzing the Problematic Knee Arthroplasty: A Systematic Review

Abstract

Background Various diagnostic modalities are available to assess the problematic knee arthroplasty. Visualization of soft‐tissue structures in relation to the arthroplasty and bone remains difficult. Recent developments in MRI sequences could make MRI a viable addition to the diagnostic arsenal. Purpose To review the diagnostic properties of MRI, to identify certain causes of complaints that may be directly related to implant failure of total (TKA) or unicompartmental knee arthroplasty (UKA); infection, loosening and wear, instability, malalignment, arthrofibrosis, or patellofemoral problems. Study Type Systematic review. Population Twenty‐three studies were included: 16 TKA, four UKA, and three cadaveric studies. Causes of knee arthroplasty complaints analyzed were; infection (three), loosening and wear (11), malalignment (five) and instability (four). Field Strength and Sequences No field strength or sequence restrictions. Assessment PubMed, SCOPUS, and EMBASE were searched. Risk of bias was assessed using the COnsensus‐based Standards for the selection of health Measurement Instruments (COSMIN) and the QUality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2). Statistical Tests The results of the original research articles are stated. Results Fifteen studies assessed the reproducibility of analyzing infection, loosening and wear, and malalignment. Fourteen of 15 studies were deemed as adequate to good quality. Results showed a moderate to excellent agreement (ICC/K 0.55–0.97). Fourteen studies addressed the accuracy. For infection and loosening and wear the sensitivity and specificity estimates varied between 0.85–0.97 and 0.70–1.00, respectively. The accuracy for malalignment was excellent (r ≥ 0.81). For these studies QUADAS‐2 analysis suggested few risks of bias. A meta‐analysis was not possible due to the heterogeneity of the data. Data Conclusion This study supports that MRI can be used with overall reproducible and accurate results for diagnosing infection, loosening and wear, and malalignment after knee arthroplasty. Nonetheless, studies regarding the diagnosis of instability, arthrofibrosis or patellofemoral complaints using MRI are limited and inconclusive. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:446–458.

Quantification of intra-articular fibrosis in patients with stiff knee arthroplasties using metal-reduction MRI

“…However, the clinician currently has no diagnostic tools available to investigate intra-articular fibrous tissue, the presence of which is only confirmed arthroscopically or at open surgery. 5 Therefore, the decision to undertake debridement can be challenging.…”

“…There is no available non-invasive test to aid the clinician investigating the patient presenting with stiffness that has failed non-surgical measures and in whom an implant-related cause cannot be found. 5 , 6…”

“… 8 , 9 However, the use of MRI to investigate problematic TKA is less well studied. 5 , 10 A meta-analysis of MRI investigation of the problematic TKA showed that studies investigating fibrosis are ‘limited and inconclusive. 5 …”

“… 5 , 10 A meta-analysis of MRI investigation of the problematic TKA showed that studies investigating fibrosis are ‘limited and inconclusive. 5 …”

re: MRI as Diagnostic Modality for Analyzing the Problematic Knee Arthroplasty: A Systematic Review

“…The systematic review by Schröder et al in this issue of the Journal of Magnetic Resonance Imaging provides a comprehensive summary of studies published between January 2003 and February 2019 reporting on the reproducibility and/or diagnostic accuracy of MRI to evaluate causes of failure for knee replacements. The authors identified 23 relevant studies, all of which were conducted at 1.5T MRI using fast spin echo and/or short‐TI inversion recovery sequences, while a subset of six studies also included advanced metal artifact reduction techniques.…”