The utility of repeat ultrasound imaging in the follow-up of metal-on-metal hip arthroplasty patients

Background and purposeThe initial outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD) were poor. Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The first article considered the various investigative modalities used during MoMHA patient surveillance (Matharu et al. 2018a). The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients (hip resurfacing and large-diameter MoM total hip arthroplasty), with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision.Results and interpretationThe outcomes following ARMD revision surgery appear to have improved with time for several reasons, among them the introduction of regular patient surveillance and lowering of the threshold for performing revision. Furthermore, registry data suggest that outcomes following ARMD revision are influenced by modifiable factors (type of revision procedure and bearing surface implanted), meaning surgeons could potentially reduce failure rates. However, additional large multi-center studies are needed to develop robust thresholds for performing ARMD revision surgery, which will guide surgeons’ treatment of MoMHA patients. The long-term systemic effects of metal ion exposure in patients with these implants must also be investigated, which will help establish whether there are any systemic reasons to recommend revision of MoMHAs

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“… 2016 , Matharu et al. 2016a ), and predictors of poor outcomes following ARMD revision (De Smet et al. 2011 , Liddle et al.…”

Section: Resultsmentioning

confidence: 99%

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

et al. 2018

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“…Therefore, periprosthetic area need to be carefully assessed in MOM THA cases in image screening. Several previous studies have demonstrated the e cacy of ultrasonography in diagnosing ARMD, but no prior report has proposed a ultrasonographic screening protocol for periprosthetic area in HRA patients (7)(8)(9)14). Hence, the major goal of our present study was to assess the accuracy of ultrasonography for this purpose using a standardized protocol that focused on the periprosthetic muscles in HRA patients and a comparison with MRI ndings.…”

Section: Discussionmentioning

confidence: 96%

“…Measurements of metal ions are a recommended screening method for possible ARMD, but can be prohibitively costly if not covered by national health insurance (10). MRI or CT scans are universal imaging modalities for the screening of pseudotumors (7)(8)(9)(11)(12)(13)(14) but implant halation prevents the careful assessment of periprosthetic soft tissues with these methods, which is problematic in the case of implant-related complications that mainly originate in these tissues. Recent improvements to the resolution in ultrasonography have enabled a more precise evaluation of various parts of body and the utility of this approach has been demonstrated for the screening of ARMD in MOMTHA patients (7)(8)(9)14).…”

Section: Introductionmentioning

confidence: 99%

Targeting of Periprosthetic Muscles for the Ultrasonographic Screening of Hip Abnormalities in Hip Resurfacing Arthroplasty Patients

Choe

Kobayashi

Ike

et al. 2020

Preprint

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Background: Hip resurfacing arthroplasty (HRA) patients require subsequent annual screening for possible post-operative complications. Ultrasonography is an established method for this purpose but lacks a screening protocol for hip joints. The purpose of this study was to evaluate the accuracy of ultrasonography for detecting post-operative complications in HRA patients using a screening protocol that specifically targets periprosthetic muscles.Methods: We enrolled 45 hips from 40 HRA patients with mean age of 50 years at the time of surgery and a mean follow-up period of 8.2 years. MRI and ultrasonography scans were simultaneously conducted at follow-up. The ultrasonography assessments were conducted on the anterior, lateral, and posterior part of the hip that targets iliopsoas, sartorius, rectus femoris, fascia tensor, short rotators, and gluteus minimus, medius, and maximus. The accuracy of diagnosing postoperative abnormalities and the detectability of periprosthetic muscles were compared between these two modalities.Results: Both MRI and ultrasonography detected an abnormal region in 8 cases comprising 2 infections, 2 pseudotumors, and 4 patients with greater trochanteric bursitis. Among these cases, 4 hips required implant removal. The increase of anterior space, measured as the distance between the iliopsoas and resurfacing head, was a good indicator for the abnormal mass in these 4 HRA cases. In the assessment of periprosthetic muscles, MRI showed a much lower detectability than ultrasonography in the iliopsoas (6.7% vs 100%), gluteus minimus (6.7% vs 88.9%), and short rotators (8.8% vs 71.4%) due to implant halation.Conclusion: With a screening protocol that targets periprosthetic muscles, ultrasonography can detect postoperative complications as effectively as MRI assessments in HRA patients. Moreover, ultrasonography has superior detectability in the periprosthetic muscles of HRA patients, indicating its utility for the screening of small legions in these cases which may not be detectable by MRI.

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“… 2013 , Matharu et al. 2016c ). It must be acknowledged that the prevalence of ARMD in MoMHAs on both ultrasound and MARS-MRI has been much higher (up to 61%) (Kwon et al.…”

Section: Hip Imagingmentioning

confidence: 99%

“… 2015b , Matharu et al. 2016c ). Hip abductor atrophy has frequently been reported in MoMHAs and can progress over 1 year, with some suggesting atrophy may be a precursor to irreversible muscle destruction (Berber et al.…”

Section: Hip Imagingmentioning

confidence: 99%

What is appropriate surveillance for metal-on-metal hip arthroplasty patients?

et al. 2017

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The unexpected high revision rates of large-diameter (femoral head sizes of 36 mm or greater) metal-on-metal hip arthroplasties (MoMHAs) have led to worldwide regulatory authorities recommending regular surveillance, even for asymptomatic individuals. However, these recommendations are not evidence-based and are very costly. The rapidly evolving evidence base requires an update regarding the investigation and management of MoMHA patients. This article is the first of 2 (the second article in this series will consider the threshold for performing revision, and the outcomes following ARMD revision surgery: Matharu et al., Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris: A clinical update. Acta Orthop 2018; in press), and considers the various investigative modalities used during surveillance, with specific focus on blood metal ion sampling and cross-sectional imaging. No single investigation can universally be used during MoMHA patient surveillance. Recent studies have now provided important information on interpreting blood metal ions (effective in identifying patients at low risk of problems), clarifying the roles of cross-sectional imaging (reserve combined ultrasound and MARS-MRI for complex cases), and providing parameters to safely exclude many asymptomatic patients from regular surveillance. This information will be useful when designing future surveillance protocols for MoMHA patients

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The utility of repeat ultrasound imaging in the follow-up of metal-on-metal hip arthroplasty patients

Abstract: Repeat ultrasound in MoMHA patients demonstrated that findings frequently progress in the short-term. Therefore, regular surveillance of MoMHA patients is important, with ultrasound representing an effective investigation for identifying the development and progression of lesions.

Cited by 15 publications

References 24 publications

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

Targeting of Periprosthetic Muscles for the Ultrasonographic Screening of Hip Abnormalities in Hip Resurfacing Arthroplasty Patients

What is appropriate surveillance for metal-on-metal hip arthroplasty patients?

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