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 Adult Hip Reconstruction Test 9: Topics of Interest in Hip Arthroplasty
CME 3: July, August, September 2004
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The Journal of Bone and Joint Surgery (American) 86:1947-1954 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Magnetic Resonance Imaging After Total Hip Arthroplasty: Evaluation of Periprosthetic Soft Tissue

Hollis G. Potter, MD1, Bryan J. Nestor, MD1, Carolyn M. Sofka, MD1, Stephanie T. Ho, MD1, Lance E. Peters, MD2 and Eduardo A. Salvati, MD1

1 Division of Magnetic Resonance Imaging (H.G.P., C.M.S., and S.T.H.) and Department of Orthopaedic Surgery (B.J.N. and E.A.S.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for H.G. Potter: potterh{at}hss.edu
2 Orthopaedic Associates, 65 Pennsylvania Avenue, Binghamton, NY 13903

Investigation performed at the Division of Magnetic Resonance Imaging and the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The evaluation of periprosthetic osteolysis in patients who have had a total hip arthroplasty is challenging, and traditional imaging techniques, including magnetic resonance imaging and computerized tomography, are limited by metallic artifact. The purpose of the present study was to investigate the use of modified magnetic resonance imaging techniques involving commercially available software to visualize periprosthetic soft tissues, to define the bone-implant interface, and to detect the location and extent of osteolysis.

Methods: Twenty-eight hips in twenty-seven patients were examined to assess the extent of osteolysis (nineteen hips), enigmatic pain (five), heterotopic ossification (two), suspected tumor (one), or femoral nerve palsy (one). The results were correlated with conventional radiographic findings as well as with intraoperative findings (when available).

Results: Magnetic resonance imaging demonstrated the bone-implant interface and the surrounding soft-tissue envelope in all hips. Radiographs consistently underestimated the extent and location of acetabular osteolysis when compared with magnetic resonance imaging. Magnetic resonance imaging also disclosed radiographically occult extraosseous soft-tissue deposits that were similar in signal intensity to areas of osteolysis, demonstrated the relationship of these deposits to adjacent neurovascular structures, and allowed further visualization of hypertrophic synovial deposits that accompanied the bone resorption in twenty-five of the twenty-eight hips.

Conclusions: Magnetic resonance imaging is effective for the assessment of the periprosthetic soft tissues in patients who have had a total hip arthroplasty. While not indicated for every patient who has pain at the site of an arthroplasty, these techniques can be effective for the evaluation of the surrounding soft-tissue envelope as well as intracapsular synovial deposits and are more effective than radiographs for the detection and evaluation of osteolysis, thus aiding in clinical management.

Level of Evidence: Diagnostic study, Level III-1 (study of nonconsecutive patients [no consistently applied reference "gold" standard]). See Instructions to Authors for a complete description of levels of evidence.


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