What Is the Natural History of "Asymptomatic" Pseudotumours in Metal-on-Metal Hip Arthroplasty? Minimum 4-Year Metal Artifact Reduction Sequence Magnetic Resonance Imaging Longitudinal Study.
Metal Artifact Reduction Sequence Magnetic Resonance Imaging (MARS-MRI) is an important cross-sectional imaging modality in detection of metal-on-metal (MoM) hip arthroplasty (HA) pseudotumours. Potential evolution of pseudotumours detected by MARS-MRI in "asymptomatic" patients with MoMHA arthroplasty beyond 2 years remains largely unknown. The aims of this longitudinal study were to (1) determine the natural history of pseudotumours in "asymptomatic" MoMHA patients under MARS-MRI surveillance and (2) characterize MRI feature(s) associated with progressive pseudotumours.



A total of 37 MoMHA (32 patients, mean 56 years old) with pseudotumours on MARS-MRI were evaluated longitudinally using a standardized MARS-MRI protocol. Serum cobalt and chromium levels, pseudotumour size, thickness of the cyst wall, and MRI signal intensity of the abnormality were recorded and analyzed.



At minimum of 4-year follow-up (range 49-54 months), 4 Type II pseudotumours (11%) demonstrated MRI evidence of progression. Five Type I pseudotumours (14%) were found to have "regressed." No measurable MRI progression was detected in remaining patients (75%). MRI features associated with progressive pseudotumours included the presence of increased cystic wall thickness and "atypical" mixed fluid signal. MRI pseudotumour progression was not associated with metal ion levels.



The natural history of type I cystic pseudotumours continues to be nonprogressive in most "asymptomatic" MoMHA patients at minimum 4 years, suggesting the importance of patient symptoms and MRI characteristic features in the clinical decision-making process. Routine follow-up MARS-MRI evaluation of "asymptomatic" patients with low-grade cystic pseudotumours in the absence of interval clinical changes may not be indicated.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Young-Min
YM
Kwon
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Ming Han Lincoln
MH
Liow
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Dimitris
D
Dimitriou
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Tsung-Yuan
TY
Tsai
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Andrew A
AA
Freiberg
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Harry E
HE
Rubash
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016477:Artifacts; D002857:Chromium / Q000097:blood; D003035:Cobalt / Q000097:blood; D018450:Disease Progression; D005260:Female; D006099:Granuloma / Q000000981:diagnostic imaging* / Q000209:etiology*; D006622:Hip Prosthesis; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D008875:Middle Aged
D002857:Chromium; D003035:Cobalt
MARS MRI; hip arthroplasty; longitudinal study; metal-on-metal; “asymptomatic” pseudotumour