Metal-on-Metal Hip Replacement: MRI Signal Intensities of Different Body Tissues and Their Relations to Blood Metal Ion Levels

Isr Med Assoc J. 2017 Nov;19(11):674-678.

Abstract

Background: Metal-on-metal total hip prostheses (MoM-THR) have been shown to produce hypersensitivity reactions and fluid collection (pseudotumor) by the hip as well as high blood metal ions levels (BMILs).

Objectives: To evaluate the magnetic resonance imaging (MRI) signal-to-noise ratio (S/N) in selected body tissues around the hip of patients who underwent MoM hip replacement and to correlate to BMILs.

Methods: Sixty-one MRI hip examinations in 54 post-MoM-THR patients (18 males, 36 females, mean age 65 years) were retrospectively evaluated independently by two readers. The mean S/N ratio in a region of interest was calculated for periprosthetic pseudotumor collection (PPC), the bladder, fat, and muscle on axial T1w, FSE-T2w, and short tau inversion recovery (STIR) sequences on the same location. BMILs were retrieved from patient files.

Results: PPC was detected in 32 patients (52%) with an average volume of 82.48 mm3. BMIL did not correlate with the presence of PPCs but positively correlated with the PPC's volume. A trend for positive correlation was found between BMILs and S/N levels of STIR images for muscle and bladder as well as for PPC and cobalt levels. A trend for correlation was also seen between BMIL with PPC's T1 w S/N.

Conclusions: Alteration of MRI S/N for different hip tissues showed a tendency for correlation with BMILs, possibly suggesting that metal deposition occurs in the PPC as well as in the surrounding tissues and bladder.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Arthroplasty, Replacement, Hip* / instrumentation
  • Arthroplasty, Replacement, Hip* / methods
  • Chromium* / adverse effects
  • Chromium* / blood
  • Cobalt* / adverse effects
  • Cobalt* / blood
  • Correlation of Data
  • Female
  • Foreign-Body Reaction / blood
  • Foreign-Body Reaction / diagnostic imaging
  • Foreign-Body Reaction / etiology
  • Granuloma, Plasma Cell* / diagnostic imaging
  • Granuloma, Plasma Cell* / etiology
  • Hip Prosthesis / adverse effects*
  • Humans
  • Hypersensitivity / diagnosis
  • Hypersensitivity / etiology
  • Israel / epidemiology
  • Magnetic Resonance Imaging / methods
  • Male
  • Metal-on-Metal Joint Prostheses / adverse effects*
  • Metals / adverse effects
  • Metals / blood
  • Middle Aged
  • Prosthesis Design
  • Prosthesis Failure
  • Retrospective Studies

Substances

  • Metals
  • Chromium
  • Cobalt