The prevalence of adverse reactions to metal debris around metal-on-metal (MOM) hip replacements has been reported to range from 7 to 69%. Little has been published on MRI scans with conventional total hip bearing surfaces. This study aimed to establish the prevalence of soft tissue lesions associated with metal-on-polyethylene (MOP) and ceramic-on-ceramic (COC) bearings, compared to MOM prostheses. All Metal Artefact Reduction Sequence (MARS) MRI scans for MOM THRs performed at our unit from January 2009 to present were reviewed, identifying those with contralateral primary MOP or COC THRs included on the scan. These were compared to a previously analysed cohort of 281 MOM THRs. Scans were classified using the Modified Oxford Classification as ‘Normal’, ‘Trochanteric Fluid’, ‘Effusions’ or Adverse Reactions to Debris.Introduction
Patients/Materials & Methods
We investigated the changes seen on serial metal
artefact reduction magnetic resonance imaging scans (MARS-MRI) of
metal-on-metal total hip arthroplasties (MoM THAs). In total 155
THAs, in 35 male and 100 female patients (mean age 70.4 years, 42
to 91), underwent at least two MRI scans at a mean interval of 14.6
months (2.6 to 57.1), at a mean of 48.2 months (3.5 to 93.3) after
primary hip surgery. Scans were graded using a modification of the
Oxford classification. Progression of disease was defined as an
increase in grade or a minimum 10% increase in fluid lesion volume
at second scan. A total of 16 hips (30%) initially classified as
‘normal’ developed an abnormality on the second scan. Of those with
‘isolated trochanteric fluid’ 9 (47%) underwent disease progression,
as did 7 (58%) of ‘effusions’. A total of 54 (77%) of hips initially
classified as showing adverse reactions to metal debris (ARMD) progressed,
with higher rates of progression in higher grades. Disease progression
was associated with high blood cobalt levels or an irregular pseudocapsule
lining at the initial scan. There was no association with changes
in functional scores. Adverse reactions to metal debris in MoM THAs
may not be as benign as previous reports have suggested. Close radiological
follow-up is recommended, particularly in high-risk groups. Cite this article:
