Periprosthetic Pathology in ‘At Risk’ Ceramic-on-Polyethylene Total HIP Arthroplasty: A Clinical Study Using MARS-MRI in 50 Patients

Abstract

Purpose Recent studies of metal-on-metal (MoM) total hip arthroplasty (THA) using metal-artefact-reducing-sequence software for magnetic resonance Imaging (MARS-MRI) have revealed remarkable soft tissue pathology around the hip, usually referred to as pseudotumours. Case reports describe identical pathology in non-MoM THA, but descriptive overviews of MRI abnormalities in patients with non-MoM prosthesis are scarce. Methods A clinical study in a cohort of 50 ceramic-on-polyethylene (CoP) THA selected for high risk of peri-prosthetic pathology including 2 subgroups: (i) 40 patients with a high polyethylene (PE) wear rate (>0.2 mm per year) and 5-12 years follow-up; (ii) 10 patients with a 2 to 5 years follow-up and a documented history of persistent complaints. All patients were clinically evaluated, MARS-MRIs were completed and chrome and cobalt serum samples were taken. Results 17 scans were normal (34%). Periprosthetic fluid collections were seen as a bursae iliopsoas (n = 12, 24%), in the trochanter bursae (n = 4, 8%) and in the surgical tract (n = 9, 18%). 1 case demonstrated a cyst on MARS-MRI resembling a pseudotumour as seen with MoM THA (2%). Intraosseous acetabular cysts were seen in 12 cases (24%), intraosseous trochanteric cysts in 10 cases (20%). Conclusions Soft tissue abnormalities after non-MoM THA are common in selected patients and can be clearly visualised with MARS-MRI. Pseudotumours as seen on MARS-MRI do occur in non-MoM hip arthroplasty but with low prevalence.