Kleeblad Laura Jill, Zuiderbaan Hendrik A, Burge Alissa J, Amirtharaj Mark J, Potter Hollis G, Pearle Andrew D
1Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021 USA.
2Department of Orthopaedic Surgery, Academic Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
HSS J. 2018 Oct;14(3):286-293. doi: 10.1007/s11420-018-9629-1. Epub 2018 Aug 23.
The most common modes of failure of cemented unicompartmental knee arthroplasty (UKA) designs are aseptic loosening and unexplained pain at short- to mid-term follow-up, which is likely linked to early fixation failure. Determining these modes of failure remains challenging; conventional radiographs are limited for use in assessing radiolucent lines, with only fair sensitivity and specificity for aseptic loosening.
QUESTIONS/PURPOSES: We sought to characterize the bone-component interface of patients with symptomatic cemented medial unicompartmental knee arthroplasty (UKA) using magnetic resonance imaging (MRI) and to determine the relationship between MRI and conventional radiographic findings.
This retrospective observational study included 55 consecutive patients with symptomatic cemented UKA. All underwent MRI with addition of multiacquisition variable-resonance image combination (MAVRIC) at an average of 17.8 ± 13.9 months after surgery. MRI studies were reviewed by two independent musculoskeletal radiologists. MRI findings at the bone-cement interface were quantified, including bone marrow edema, fibrous membrane, osteolysis, and loosening. Radiographs were reviewed for existence of radiolucent lines. Inter-rater agreement was determined using Cohen's statistic.
The vast majority of symptomatic UKA patients demonstrated bone marrow edema pattern (71% and 75%, respectively) and fibrous membrane (69% and 89%, respectively) at the femoral and tibial interface. Excellent and substantial inter-rater agreement was found for the femoral and tibial interface, respectively. Furthermore, MRI findings and radiolucent lines observed on conventional radiographs were poorly correlated.
MRI with the addition of MAVRIC sequences could be a complementary tool for assessing symptomatic UKA and for quantifying appearances at the bone-component interface. This technique showed good reproducibility of analysis of the bone-component interface after cemented UKA. Future studies are necessary to define the bone-component interface of symptomatic and asymptomatic UKA patients.
骨水泥型单髁膝关节置换术（UKA）设计最常见的失败模式是无菌性松动以及在短期至中期随访时出现无法解释的疼痛，这可能与早期固定失败有关。确定这些失败模式仍然具有挑战性；传统X线片在评估透亮线方面存在局限性，对无菌性松动的敏感性和特异性仅为中等。
问题/目的：我们试图使用磁共振成像（MRI）来描述有症状的骨水泥型内侧单髁膝关节置换术（UKA）患者的骨-假体界面，并确定MRI与传统X线片检查结果之间的关系。
这项回顾性观察研究纳入了55例连续的有症状的骨水泥型UKA患者。所有患者均在术后平均17.8±13.9个月时接受了MRI检查，并加用了多采集可变共振图像组合（MAVRIC）序列。MRI研究由两名独立的肌肉骨骼放射科医生进行评估。对骨水泥-骨界面的MRI表现进行量化，包括骨髓水肿、纤维膜、骨溶解和松动。对X线片进行评估以确定是否存在透亮线。使用科恩统计量确定评分者间的一致性。
绝大多数有症状的UKA患者在股骨和胫骨界面表现出骨髓水肿模式（分别为71%和75%）和纤维膜（分别为69%和89%）。在股骨和胫骨界面分别发现了评分者间的高度一致性和实质性一致性。此外，MRI表现与传统X线片上观察到的透亮线之间相关性较差。
加用MAVRIC序列的MRI可能是评估有症状的UKA以及量化骨-假体界面表现的一种补充工具。该技术在骨水泥型UKA术后对骨-假体界面的分析显示出良好的可重复性。未来有必要开展研究以明确有症状和无症状UKA患者的骨-假体界面情况。
