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

Abstract

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.

Metal Articulations as a Source of Total Hip Arthroplasty Pain

“…The risk factors associated with early complications of revision surgery for ALTR due to MACC in patients with MoP THA include prerevision MRI findings of a solid lesion with abductor deficiency and intraoperative tissue damage [51]. Dislocation and re-revision procedures were strongly associated with the magnitude of necrotic tissue identified intraoperatively, highlighting the importance of a systematic approach in evaluating symptomatic MoP THA patients in order for early recognition and to optimize patient outcomes [52]. When a differential diagnosis of ALTR due to MACC is considered, a systematic evaluation should include serum metal level measurement and MARS MRI as early diagnosis will facilitate the initiation of appropriate treatment prior to significant tissue necrosis.…”