Periprosthetic Pathology in 'At Risk' Ceramic-on-Polyethylene Total HIP Arthroplasty: A Clinical Study Using MARS-MRI in 50 Patients. Issue 3 (16th May 2016)

• Record Type: Journal Article
• Authors: Das, Dirk H.; van der Weegen, Walter; Wullems, Jorgen A.; Brakel, Koen; Sijbesma, Thea; Nelissen, Rob G.
• Is Part Of: Hip international. Volume 26:Issue 3(2016)
• Page Start: 244
• Page End: 248
• Publication Date: 2016-05-16
• Subjects: Ceramic-on-polyethylene total hip arthroplasty -- MARS-MRI -- Pseudotumours -- Soft-tissue pathology; Hip joint -- Pathophysiology -- Periodicals; Hip joint -- Diseases -- Periodicals; Hip joint -- Surgery -- Periodicals; 617.581005
• DOI: 10.5301/hipint.5000342
• Languages: English
• ISSNs: 1120-7000

Abstract

Purpose: Recent studies of metal-on-metal (MoM) total hip arthroplasty (THA) using metal-artefact-reducing-sequence software for magnetic resonance Imaging (MARS-MRI) have revealed remarkable soft tissue pathology around the hip, usually referred to as pseudotumours. Case reports describe identical pathology in non-MoM THA, but descriptive overviews of MRI abnormalities in patients with non-MoM prosthesis are scarce. Methods: A clinical study in a cohort of 50 ceramic-on-polyethylene (CoP) THA selected for high risk of peri-prosthetic pathology including 2 subgroups: (i) 40 patients with a high polyethylene (PE) wear rate (>0.2 mm per year) and 5-12 years follow-up; (ii) 10 patients with a 2 to 5 years follow-up and a documented history of persistent complaints. All patients were clinically evaluated, MARS-MRIs were completed and chrome and cobalt serum samples were taken. Results: 17 scans were normal (34%). Periprosthetic fluid collections were seen as a bursae iliopsoas (n = 12, 24%), in the trochanter bursae (n = 4, 8%) and in the surgical tract (n = 9, 18%). 1 case demonstrated a cyst on MARS-MRI resembling a pseudotumour as seen with MoM THA (2%). Intraosseous acetabular cysts were seen in 12 cases (24%), intraosseous trochanteric cysts in 10 cases (20%). Conclusions: Soft tissue abnormalities after non-MoM THA are common in selected patients and can be clearly visualised with MARS-MRI. Pseudotumours as seen on MARS-MRI do occur in non-MoM hip arthroplasty but with low prevalence.