MRI of THA Correlates With Implant Wear and Tissue Reactions: A Cross-sectional Study
MRI of THA Correlates With Implant Wear and Tissue Reactions: A Cross-sectional Study
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DOI：
10.1097/corr.0000000000000535
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发表时间：
2019-01-01
影响因子：
4.2
通讯作者：
Potter, Hollis G.
中科院分区：
文献类型：
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作者：
Koff, Matthew F.;Esposito, Christina;Potter, Hollis G.
背景MRI可预测THA后的不良局部组织反应（ALTR），但MRI如何直接与植入物表面磨损、微动磨损和植入物组件之间不同关节处的耳轴腐蚀相关尚不清楚。MRI产生高对比度图像以显示关节成形术周围的软组织，并且可以为外科医生提供区分和区分宿主相关滑膜模式的方法，作为对聚乙烯磨损或金属磨损和腐蚀产物的反应。和从回收的部件磨损;（2）根据关节面材料的不同，区分THA患者在MRI上独特的滑膜反应。（181例患者，187例髋关节），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，或接受翻修手术的组配式股骨颈设计（2013年10月至2017年6月期间）接受了术前MRI检查。对关节面设盲的一名阅片人对滑膜反应进行了评估（Gwet AC 1，0.65-0.97）;将这些数据与一名阅片人对组织样本进行的半定量组织学分析（Gwet AC 1，0.92）以及使用Goldberg评分（Gwet AC 1，0.60-0.79）对取出部件进行的半定量磨损、腐蚀和微动磨损分析进行了比较。还对植入物磨损进行了直接非接触测量。相关性和方差分析被用来评估指标之间的关联和差异的植入物types.Results之间的相关性MRI滑膜厚度与微动磨损和腐蚀损伤的严重程度之间的女性股骨头颈耳轴的模块化设计（r = 0.26 [95%置信区间{CI}，0.12-0.39]; p = 0.015，n = 185）以及MoM关节面的ALTR等级和体积磨损（r = 0.93 [95% CI，0.72-0.98]; p < 0.001，n = 10）。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患者的MRI滑膜厚度最高。在MRI上，MoP髋关节表现出明显的聚合物滑膜反应，而HRA、MoM和组配式髋关节更常表现出ALTR。在MRI上被归类为具有聚合物滑液反应的髋关节在组织样本中存在更多颗粒。结论在这项研究中，我们证明THA的MRI可以区分反映植入THA支承类型的滑液反应，并与直接测量相关植入物磨损、腐蚀和微动以及假体周围组织中磨损颗粒的组织学评估。MRI提供了一种直接、非侵入性地观察宿主产生的滑膜反应的方法。关节成形术疼痛的患者可能会被评估其不适的原因，特别是强调任何有关的滑膜反应，这将需要更迅速的手术干预。未来的研究将受益于对不同植入物的前瞻性评价，以评估关节置换术并发症的自然纵向史，包括关节面结构中ALTR的发展和患病率。证据等级III，诊断研究。
Background 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.Methods 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 non-contact 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.Results 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 (r = 0.26 [95% confidence interval {CI}, 0.12-0.39]; p = 0.015, n = 185) and ALTR grade and volumetric wear in MoM bearings (r = 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.Conclusions 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 of Evidence Level III, diagnostic study.