MRI may identify adverse local tissue reaction after THA
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Published results showed MRI may identify adverse local tissue reactions or metallosis among patients who underwent a hip replacement, even when patients are high-functioning and have no symptoms.
Matthew F. Koff, PhD, and colleagues performed MRI examination, blood serum ion testing and collected hip disability and osteoarthritis outcome score (HOOS) surveys at baseline and up to 3 years postoperatively among 206 patients with degenerative joint disease who underwent hip resurfacing arthroplasty, ceramic-on-ceramic total hip arthroplasty, metal-on-polyethylene THA or ceramic-on-polyethylene THA between March 2014 and February 2019. A single radiologist not involved in the care of the patients evaluated morphologic and susceptibility-reduced MRIs for the presence and classification of synovitis, synovial thickness and volume.
Researchers compared the mean synovial thickness, synovial volume and HOOS subscales between bearing surfaces at each timepoint and within each bearing surface over time using linear mixed-effects models. Researchers also used marginal Cox proportional hazards models, adjusted for age, sex, BMI and length of implantation based on known confounders for hip arthroplasty, to compare the time to and the risk of developing adverse local tissue reactions only, metallosis only and adverse local tissue reactions or metallosis between bearing surfaces.
Results showed higher cobalt and chromium serum ion levels among patients with unilateral hip resurfacing arthroplasty vs. patients with unilateral ceramic-on-polyethylene bearings at all timepoints. Researchers identified adverse local tissue reaction or metallosis in more patients who received hip resurfacing arthroplasty compared with patients with ceramic-on-polyethylene bearings.
Researchers found no association between the longitudinal change of synovial reaction to adverse local tissue reaction or metallosis on MRI with patient-reported outcomes, as well as no association between the presence of dehiscence at baseline and the subsequent development of adverse local tissue reaction or metallosis as seen on MRI. Patients with unilateral hip resurfacing arthroplasty who had an adverse local tissue reaction or metallosis present on MRI at 1 year postoperatively had elevated cobalt and chromium serum levels vs. patients without an adverse local tissue reaction or metallosis on MRI, as well as for chromium at 3 years postoperatively, according to results.
“People with a high-functioning hip resurfacing arthroplasty may have an adverse local tissue reaction or metallosis present in the surrounding soft tissues even when no pain is present and serum metal ion levels are not elevated,” Koff, lead study author from Hospital for Special Surgery, told Healio Orthopedics. “As new THA implant designs are developed in the future, this report and our prior studies show that MRI will continue to be an effective means to non-invasively evaluate soft tissues around total hip replacements.”
Reference:
news.hss.edu/hss-study-finds-that-mri-identifies-adverse-tissue-reactions-are-common-in-asymptomatic-individuals-after-hip-resurfacing-arthroplasty/
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