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Delayed gadolinium-enhanced MRI predicts early joint failures
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Researchers found delayed gadolinium-enhanced MRIs of cartilage reliably predicted early joint failure in patients with hip dysplasia after Bernese periacetabular osteotomies.
Delayed gadolinium-enhanced MRIs of cartilage (dGEMRICs) accurately predicted early joint failures in patients with osteoarthritis undergoing Bernese periacetabular osteotomies in clinical studies, the authors said. The authors tested the method on the “regional variations in biochemical composition” of dysplastic hips, according to the study abstract.
The researchers conducted a retrospective analysis of 43 hips in 41 patients who had undergone periacetabular osteotomy for hip dysplasia. They noted premature failures in six patients due to pain, joint space narrowing or subsequent total hip arthroplasty. They measured the hips for variations in biochemical composition using dGEMRIC and then analyzed preoperative demographics, clinical outcome scores, radiographs of osteoarthritis, severity of dysplasia and dGEMRIC indexes using multivariate analyses. The mean follow-up was 32 months.
Age and sex distribution, severity of dysplasia in terms of lateral center-edge, anterior center-edge and Tönnis angles were similar between groups. The researchers found differences in preoperative pain, joint space width, Tönnis grade and coronal and saggital dGEMRIC indexes between groups. The dGEMRIC index of the anterior weight bearing region of the prematurely failed hips was lower than the 37 preserved hips and considered “the best predictor of joint failure,” according to the study authors.
Perspective
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Michael Leunig, MD
At the Carl T. Brighton Workshop 2011 in Tampa, Florida, USA, the research group of Michael B. Millis, MD, and Young Jo Kim, MD, PhD, presented a study entitled, “Anterior delayed enhanced- gadolinium MRI of cartilage values predict cartilage failure after periacetabular osteotomy.“ This research group has long-standing experience in the use of delayed enhanced-gadolinium MRI of cartilage or dGEMRIC to predict the outcome of joint preserving surgery for developmental dysplastic hip disease and femoroacetabular impingement. The dGEMRIC technique has already been described 15 years ago in 1997 by Bashir and colleagues. However, this technique is complex to implement and it is challenging to obtain reproducible results. Therefore, it has not yet found its way into the clinical routine. In my opinion, dGEMRIC is still rather experimental, but its results are promising and I hope with technical refinements it will be soon applicable to clinical routine use.
Reference:
Bashir A. Radiology. 1997; 205:551-558.
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