M. F. Koff, P. Shah, M. Miranda, H. G. Potter, MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA C. Esposito, E. Baral, T. Wright, Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA K. Fields, Healthcare Research Institute, Hospital for Special Surgery, New York, NY, USA T. Bauer, Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA D. E. Padgett, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA.
Clin Orthop Relat Res. 2019 Jan;477(1):159-174. doi: 10.1097/CORR.0000000000000535.
MRI is predictive of adverse local tissue reactions (ALTRs) after THA but how MRI directly relates to implant surface wear, fretting, and trunnion corrosion at different articulations between implant components remains unclear. MRI generates high-contrast images to display soft tissues around arthroplasty and may provide a surgeon the means to distinguish and differentiate host-related synovial patterns as a response to either polyethylene wear or metal wear and corrosion products.
QUESTIONS/PURPOSES: The purposes of this study were (1) to correlate findings from MRI in patients who have undergone THA with direct assessment of implant wear, corrosion, and fretting from retrieved components; and (2) to distinguish the unique synovial responses on MRI in patients who have undergone THA based on bearing materials.
In this prospective study, patients undergoing THA (181 patients, 187 hips) with metal-on-metal (MoM), hip resurfacing (HRA), metal-on-polyethylene (MoP), ceramic-on-polyethylene, ceramic-on-ceramic, or modular neck designs having revision surgery (between October 2013 and June 2017) underwent preoperative MRI. A single reader blinded to the bearing surface made an assessment of the synovial response (Gwet's AC1, 0.65-0.97); these data were compared with semiquantitative histology of tissue samples by a single reader (Gwet's AC1, 0.92) and semiquantitative wear, corrosion, and fretting analysis of retrieved components using Goldberg scoring (Gwet's AC1, 0.60-0.79). Direct noncontact measurements of implant wear were also made. Correlations and analyses of variance were used to assess associations between metrics and differences by implant type, respectively.
Correlations were found between MRI synovial thickness with severity of fretting and corrosion damage of the female head-neck trunnion of femoral stems in modular designs (ρ = 0.26 [95% confidence interval {CI}, 0.12-0.39]; p = 0.015, n = 185) and ALTR grade and volumetric wear in MoM bearings (ρ = 0.93 [95% CI, 0.72-0.98]; p < 0.001, n = 10). MRI synovial thickness was highest in patients identified with aseptic lymphocyte-dominated vasculitis-associated lesions and diffuse tissue necrosis. On MRI, MoP hips demonstrated a distinct polymeric synovial response, whereas HRA, MoM, and modular hips more commonly demonstrated ALTR. Hips classified as having a polymeric synovial response on MRI had a greater number of particles present in tissue samples.
In this study, we demonstrated that MRI of THA can distinguish synovial responses that reflect the bearing type of the implanted THA and correlate to direct measurements of implant wear, corrosion, and fretting and histologic assessment of wear particles in periprosthetic tissues. MRI provides a means of direct, noninvasive visualization of the host-generated synovial response. Patients presenting with painful arthroplasties may be evaluated for the cause of their discomfort, specifically highlighting any concerning synovial reactions that would warrant more prompt surgical intervention. Future studies would benefit from a prospective evaluation of different implants to assess the natural longitudinal history of arthroplasty complications, including the development and prevalence of ALTR across bearing constructs.
Level III, diagnostic study.
MRI 可预测 THA 后的不良局部组织反应（ALTR），但 MRI 如何直接与不同假体组件之间的植入物表面磨损、微动和轴颈腐蚀相关，目前尚不清楚。MRI 生成高对比度图像来显示关节置换周围的软组织，并且可以为外科医生提供一种手段，以区分和区分宿主相关的滑膜模式，作为对聚乙烯磨损或金属磨损和腐蚀产物的反应。
问题/目的：本研究的目的是（1）将接受过 THA 的患者的 MRI 结果与从取出的部件进行的直接评估磨损、腐蚀和微动进行相关；（2）根据轴承材料，在接受过 THA 的患者中区分 MRI 上独特的滑膜反应。
在这项前瞻性研究中，接受金属对金属（MoM）、髋关节表面置换（HRA）、金属对聚乙烯（MoP）、陶瓷对聚乙烯、陶瓷对陶瓷或模块化颈设计的 THA（181 例患者，187 髋）患者在翻修手术（2013 年 10 月至 2017 年 6 月）之前接受了术前 MRI。一位盲于轴承表面的读者对滑膜反应进行评估（Gwet's AC1，0.65-0.97）；这些数据与组织样本的半定量组织学（Gwet's AC1，0.92）和使用 Goldberg 评分的取出部件的半定量磨损、腐蚀和微动分析（Gwet's AC1，0.60-0.79）进行了比较。还对植入物磨损进行了直接非接触测量。分别使用相关分析和方差分析来评估度量之间的关联和不同植入物类型之间的差异。
在模块化设计的股骨柄女性头颈轴颈的微动和腐蚀损伤严重程度与 MRI 滑膜厚度之间（ρ=0.26 [95%置信区间{CI}，0.12-0.39]；p=0.015，n=185）和 MoM 轴承的 ALTR 分级和体积磨损与 MRI 滑膜厚度之间（ρ=0.93 [95% CI，0.72-0.98]；p<0.001，n=10）发现了相关性。在被诊断为无菌性淋巴细胞为主的血管炎相关病变和弥漫性组织坏死的患者中，MRI 滑膜厚度最高。在 MRI 上，MoP 髋关节表现出明显的聚合滑膜反应，而 HRA、MoM 和模块化髋关节更常见的是 ALTR。在 MRI 上被归类为具有聚合滑膜反应的髋关节在组织样本中具有更多的颗粒存在。
在这项研究中，我们证明了 THA 的 MRI 可以区分反映植入物 THA 轴承类型的滑膜反应，并与植入物磨损、腐蚀和微动的直接测量以及假体周围组织中磨损颗粒的组织学评估相关。MRI 提供了一种直接、非侵入性的方法来可视化宿主产生的滑膜反应。出现疼痛性关节置换的患者可能会评估其不适的原因，特别是强调任何需要更及时手术干预的令人担忧的滑膜反应。未来的研究将受益于对不同植入物的前瞻性评估，以评估关节置换并发症的自然纵向病史，包括在不同轴承结构中 ALTR 的发展和流行程度。
III 级，诊断研究。
