A Comparison of the Diagnostic Accuracy of MARS MRI and Ultrasound of the Painful Metal-on-metal Hip Arthroplasty

Overview

Journal Acta Orthop

Specialty Orthopedics

Date 2014 Apr 4

PMID 24694273

Citations 25

Authors

Imran A Siddiqui

Shiraz A Sabah

Keshthra Satchithananda

Adrian K Lim

Suzie Cro

Johann Henckel

John A Skinner

Alister J Hart

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Metal artifact reduction sequence (MARS) MRI and ultrasound scanning (USS) can both be used to detect pseudotumors, abductor muscle atrophy, and tendinous pathology in patients with painful metal-on-metal (MOM) hip arthroplasty. We wanted to determine the diagnostic test characteristics of USS using MARS MRI as a reference for detection of pseudotumors and muscle atrophy. PatienTS AND METHODS: We performed a prospective cohort study to compare MARS MRI and USS findings in 19 consecutive patients with unilateral MOM hips. Protocolized USS was performed by consultant musculoskeletal radiologists who were blinded regarding clinical details. Reports were independently compared with MARS MRI, the imaging gold standard, to calculate predictive values.

Results: The prevalence of pseudotumors on MARS MRI was 68% (95% CI: 43-87) and on USS it was 53% (CI: 29-76). The sensitivity of USS in detecting pseudotumors was 69% (CI 39-91) and the specificity was 83% (CI: 36-97). The sensitivity of detection of abductor muscle atrophy was 47% (CI: 24-71). In addition, joint effusion was detected in 10 cases by USS and none were seen by MARS MRI.

Interpretation: We found a poor agreement between USS and MARS MRI. USS was inferior to MARS MRI for detection of pseudotumors and muscle atrophy, but it was superior for detection of joint effusion and tendinous pathologies. MARS MRI is more advantageous than USS for practical reasons, including preoperative planning and longitudinal comparison.

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References

Almousa S, Greidanus N, Masri B, Duncan C, Garbuz D . The natural history of inflammatory pseudotumors in asymptomatic patients after metal-on-metal hip arthroplasty. Clin Orthop Relat Res. 2013; 471(12):3814-21. PMC: 3825901. DOI: 10.1007/s11999-013-2944-4. View

Siddiqui I, Sabah S, Satchithananda K, Lim A, Henckel J, Skinner J . Cross-sectional imaging of the metal-on-metal hip prosthesis: the London ultrasound protocol. Clin Radiol. 2013; 68(8):e472-8. DOI: 10.1016/j.crad.2013.02.003. View

Liddle A, Satchithananda K, Henckel J, Sabah S, Vipulendran K, Lewis A . Revision of metal-on-metal hip arthroplasty in a tertiary center: a prospective study of 39 hips with between 1 and 4 years of follow-up. Acta Orthop. 2013; 84(3):237-45. PMC: 3715818. DOI: 10.3109/17453674.2013.797313. View

Fang C, Harvie P, GIbbons C, Whitwell D, Athanasou N, Ostlere S . The imaging spectrum of peri-articular inflammatory masses following metal-on-metal hip resurfacing. Skeletal Radiol. 2008; 37(8):715-22. DOI: 10.1007/s00256-008-0492-x. View

Nishii T, Sakai T, Takao M, Yoshikawa H, Sugano N . Ultrasound screening of periarticular soft tissue abnormality around metal-on-metal bearings. J Arthroplasty. 2011; 27(6):895-900. DOI: 10.1016/j.arth.2011.09.015. View

Sofka C, Haddad Z, Adler R . Detection of muscle atrophy on routine sonography of the shoulder. J Ultrasound Med. 2004; 23(8):1031-4. DOI: 10.7863/jum.2004.23.8.1031. View

Douis H, Dunlop D, Pearson A, OHara J, James S . The role of ultrasound in the assessment of post-operative complications following hip arthroplasty. Skeletal Radiol. 2012; 41(9):1035-46. DOI: 10.1007/s00256-012-1390-9. View

Foldes K, Gaal M, Balint P, Nemenyi K, Kiss C, Balint G . Ultrasonography after hip arthroplasty. Skeletal Radiol. 1992; 21(5):297-9. DOI: 10.1007/BF00241767. View

Sabah S, Mitchell A, Henckel J, Sandison A, Skinner J, Hart A . Magnetic resonance imaging findings in painful metal-on-metal hips: a prospective study. J Arthroplasty. 2010; 26(1):71-6, 76.e1-2. DOI: 10.1016/j.arth.2009.11.008. View

10.

Garcia F, Ferraz Picado C, Nogueira-Barbosa M . Sonographic evaluation of the abductor mechanism after total hip arthroplasty. J Ultrasound Med. 2010; 29(3):465-71. DOI: 10.7863/jum.2010.29.3.465. View

11.

Long S, Surrey D, Nazarian L . Common sonographic findings in the painful hip after hip arthroplasty. J Ultrasound Med. 2012; 31(2):301-12. DOI: 10.7863/jum.2012.31.2.301. View

12.

Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons C . Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 2008; 90(7):847-51. DOI: 10.1302/0301-620X.90B7.20213. View

13.

Hart A, Satchithananda K, Liddle A, Sabah S, McRobbie D, Henckel J . Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging. J Bone Joint Surg Am. 2012; 94(4):317-25. DOI: 10.2106/JBJS.J.01508. View

14.

Yanny S, Cahir J, Barker T, Wimhurst J, Nolan J, Goodwin R . MRI of aseptic lymphocytic vasculitis-associated lesions in metal-on-metal hip replacements. AJR Am J Roentgenol. 2012; 198(6):1394-402. DOI: 10.2214/AJR.11.7504. View

15.

Kwon Y, Ostlere S, McLardy-Smith P, Athanasou N, Gill H, Murray D . "Asymptomatic" pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalence and metal ion study. J Arthroplasty. 2010; 26(4):511-8. DOI: 10.1016/j.arth.2010.05.030. View

16.

Willert H, Buchhorn G, Fayyazi A, Flury R, Windler M, Koster G . Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am. 2005; 87(1):28-36. DOI: 10.2106/JBJS.A.02039pp. View

17.

Davies A, Willert H, Campbell P, Learmonth I, Case C . An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. J Bone Joint Surg Am. 2005; 87(1):18-27. DOI: 10.2106/JBJS.C.00949. View

18.

Smith A, Dieppe P, Vernon K, Porter M, Blom A . Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet. 2012; 379(9822):1199-204. DOI: 10.1016/S0140-6736(12)60353-5. View

19.

Hart A, Sabah S, Henckel J, Lewis A, Cobb J, Sampson B . The painful metal-on-metal hip resurfacing. J Bone Joint Surg Br. 2009; 91(6):738-44. DOI: 10.1302/0301-620X.91B6.21682. View

20.

Smidt N, Rutjes A, van der Windt D, Ostelo R, Reitsma J, Bossuyt P . Quality of reporting of diagnostic accuracy studies. Radiology. 2005; 235(2):347-53. DOI: 10.1148/radiol.2352040507. View