Similar incidence of periprosthetic fluid collections after ceramic-on-polyethylene total hip arthroplasties and metal-on-metal resurfacing arthroplasties: results of a screening metal artefact reduction sequence-MRI study.
Patients from a randomised trial on resurfacing hip arthroplasty (RHA) (n = 36, 19 males; median age 57 years, 24 to 65) comparing a conventional 28 mm metal-on-metal total hip arthroplasty (MoM THA) (n = 28, 17 males; median age 59 years, 37 to 65) and a matched control group of asymptomatic patients with a 32 mm ceramic-on-polyethylene (CoP) THA (n = 33, 18 males; median age 63 years, 38 to 71) were cross-sectionally screened with metal artefact reducing sequence-MRI (MARS-MRI) for pseudotumour formation at a median of 55 months (23 to 72) post-operatively. MRIs were scored by consensus according to three different classification systems for pseudotumour formation. Clinical scores were available for all patients and metal ion levels for MoM bearing patients. Periprosthetic lesions with a median volume of 16 mL (1.5 to 35.9) were diagnosed in six patients in the RHA group (17%), one in the MoM THA group (4%) and six in the CoP group (18%). The classification systems revealed no clear differences between the groups. Solid lesions (n = 3) were exclusively encountered in the RHA group. Two patients in the RHA group and one in the MoM THA group underwent a revision for pseudotumour formation. There was no statistically significant relationship between clinical scoring, metal ion levels and periprosthetic lesions in any of the groups. Periprosthetic fluid collections are seen on MARS-MRI after conventional CoP THA and RHA and may reflect a soft-tissue collection or effusion. Currently available MRI classification systems seem to score these collections as pseudotumours, causing an-overestimatation of the incidence of pseudotumours.
Rijnstate Hospital, Postbus 9555, 6800 TA Arnhem, The Netherlands.
P
P
Bisseling
Rijnstate Hospital, Postbus 9555, 6800 TA Arnhem, The Netherlands.
B W K
BW
de Wit
Rijnstate Hospital, Postbus 9555, 6800 TA Arnhem, The Netherlands.
A M
AM
Hol
Rijnstate Hospital, Postbus 9555, 6800 TA Arnhem, The Netherlands.
M J
MJ
van Gorp
Radboud University Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
A
A
van Kampen
Rijnstate Hospital, Postbus 9555, 6800 TA Arnhem, The Netherlands.
J L C
JL
van Susante
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D016477:Artifacts; D002516:Ceramics; D003430:Cross-Sectional Studies; D005122:Exudates and Transudates; D005260:Female; D006104:Granuloma, Plasma Cell / Q000175:diagnosis / Q000209:etiology*; D006621:Hip Joint / Q000473:pathology*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D008875:Middle Aged; D020959:Polyethylene; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000209:etiology; D012086:Reoperation / Q000379:methods; D012720:Severity of Illness Index
D020959:Polyethylene
Ceramic-on-polyethylene total hip arthroplasty; MRI; Metal-on-metal total hip arthroplasty; Pseudotumor; Resurfacing hip arthroplasty; pseudotumour