Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
J Bone Joint Surg Am. 2013 May 15;95(10):895-902. doi: 10.2106/JBJS.K.01476.
Although pseudotumors have been reported at the sites of well-functioning and painful metal-on-metal hip prostheses, there are no objective data on the magnitude of the adverse reaction. This observational study was performed to investigate the ability of modified magnetic resonance imaging (MRI) to detect and quantify adverse synovial responses in symptomatic and asymptomatic subjects following metal-on-metal hip resurfacing. We hypothesized that the magnitude of the synovial reactions would be greater in symptomatic patients.
Sixty-nine patients (seventy-four hips) with hip resurfacing were divided into three groups: asymptomatic (twenty-two hips), symptomatic with a mechanical cause (twenty), and unexplained pain (thirty-two). The volume of synovitis was calculated on MRI for all patients.
Synovitis was detected in fifteen asymptomatic hips (68%), fifteen (75%) with symptoms with a mechanical causes, and twenty-five (78%) with unexplained pain. The mean volume (and standard deviation) of the synovitis in these groups was 5 ± 7 cm³, 10 ± 16 cm³, and 31 ± 47 cm³, respectively. The coefficient of repeatability between the examiners was 1.8 cm³ for measurement of synovitis. Of the thirteen subjects with revision arthroplasty, six had an adverse local tissue reaction. This subgroup had the highest volumes of synovitis on MRI.
An adverse synovial reaction was detected on MRI in both symptomatic and asymptomatic subjects. We found a larger volume of synovitis in symptomatic patients; this increase reached significance only in the group with an adverse local tissue reaction. Synovial volume on MRI may be a valuable marker in the longitudinal assessment of asymptomatic patients with a metal-on-metal hip resurfacing and in identifying patients with adverse local tissue reaction.
虽然在功能良好且有疼痛的金属对金属髋关节假体部位已报告假性肿瘤，但对于不良反应的严重程度尚无客观数据。本观察性研究旨在探究改良磁共振成像（MRI）在检测和量化金属对金属髋关节表面置换术后有症状和无症状患者的关节滑膜不良反应方面的能力。我们假设在有症状的患者中滑膜反应的严重程度会更高。
将 69 例（74 髋）髋关节表面置换患者分为三组：无症状（22 髋）、有症状且为机械性原因（20 髋）和原因不明的疼痛（32 髋）。对所有患者的 MRI 滑膜体积进行计算。
15 例无症状髋关节（68%）、15 例（75%）机械性原因所致症状和 25 例（78%）原因不明疼痛患者中均检测到滑膜炎。这些组的滑膜炎症平均体积（标准差）分别为 5 ± 7cm³、10 ± 16cm³和 31 ± 47cm³。观察者之间的可重复性系数为滑膜炎症的 1.8cm³。在 13 例接受翻修关节成形术的患者中，有 6 例存在不良局部组织反应。该亚组的 MRI 滑膜炎症体积最大。
MRI 检测到有症状和无症状患者均存在不良滑膜反应。我们发现有症状患者的滑膜炎症体积更大；但仅在不良局部组织反应组中达到显著差异。MRI 滑膜体积可能是金属对金属髋关节表面置换后无症状患者纵向评估和识别不良局部组织反应患者的一个有价值的标志物。
