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Stimolo D, Muratori F, Cucurullo L, Scoccianti G, Innocenti M, Campanacci DA. Pseudotumor following total hip arthroplasty: experience of a tertiary referral center and proposal of the new "PCS" classification system. Arch Orthop Trauma Surg 2025; 145:168. [PMID: 39969639 PMCID: PMC11839790 DOI: 10.1007/s00402-025-05766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 01/15/2025] [Indexed: 02/20/2025]
Abstract
INTRODUCTION This study summarizes outcomes in treating pseudotumors of the hip at a tertiary referral center and introduces a classification system to aid treatment decisions and enhance communication among providers. MATERIALS AND METHODS We collected data from 39 patients who underwent surgery for hip pseudotumor, analyzing implant failures based on patient history, revision reasons, bearing surface type, mass location and size, bone loss, revision type, and whether it was single- or two-stage. We introduce the PCS classification: 'P' for Pseudotumor (with 's' for symptomatic, 'e/I' for intra/extrapelvic location, and 'm' for high Chromium/Cobalt levels), 'C' for implant status, and 'S' for bone loss extent. In 37 patients, we evaluated Cohen's kappa coefficient to evaluate interobserver reliability. RESULTS Twenty (51.2%) patients were female, with a mean age of 71 years (range 36-89; σ 12.11); the mean follow-up duration was 54.43 months (range 12.2-128.3). The average size of the pseudotumor was 13.10 cm (range 3.3-37.2; σ 7.11) with 61.5% exhibiting extra-pelvic localization only. Bearing surfaces were MoM in 27 patients (69.2%). Single-stage revision surgery was performed in 87.1% of patients. There were 7 (17.9%) implant failures. No significant differences in failure rates were observed based on considered parameters. The agreement following Cohen's coefficient for the combined PCS classification was k = 0.43. Moderate to almost perfect agreement was obtained for parameter P and S, with k = 0.48 for parameter C. CONCLUSION No correlation was found between failures and analyzed characteristics. Our classification assesses clinical scenarios and stratifies surgical complexity for indication purposes. While interobserver agreement varies with parameter C, it is consistent with parameters P and S.
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Affiliation(s)
- Davide Stimolo
- University of Florence, Florence, Italy.
- Careggi University Hospital, Florence, Italy.
| | | | - Lorenzo Cucurullo
- University of Florence, Florence, Italy
- Careggi University Hospital, Florence, Italy
| | - Guido Scoccianti
- University of Florence, Florence, Italy
- Careggi University Hospital, Florence, Italy
| | - Matteo Innocenti
- University of Florence, Florence, Italy
- Careggi University Hospital, Florence, Italy
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van Lingen CP, Ettema HB, Bosker BH, Verheyen CCPM. Ten-year results of a prospective cohort of large-head metal-on-metal total hip arthroplasty. Bone Jt Open 2022; 3:61-67. [PMID: 35043691 PMCID: PMC9047076 DOI: 10.1302/2633-1462.31.bjo-2021-0159.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aims Large-diameter metal-on-metal (MoM) total hip arthroplasty (THA) has demonstrated unexpected high failure rates and pseudotumour formation. The purpose of this prospective cohort study is to report ten-year results in order to establish revision rate, prevalence of pseudotumour formation, and relation with whole blood cobalt levels. Methods All patients were recalled according to the guidelines of the Dutch Orthopaedic Association. They underwent clinical and radiographical assessments (radiograph and CT scan) of the hip prosthesis and whole blood cobalt ion measurements. Overall, 94 patients (95 hips) fulfilled our requirements for a minimum ten-year follow-up. Results Mean follow-up was 10.9 years (10 to 12), with a cumulative survival rate of 82.4%. Reason for revision was predominantly pseudotumour formation (68%), apart from loosening, pain, infection, and osteolysis. The prevalence of pseudotumour formation around the prostheses was 41%, while our previous report of this cohort (with a mean follow-up of 3.6 years) revealed a 39% prevalence. The ten-year revision-free survival with pseudotumour was 66.7% and without pseudotumour 92.4% (p < 0.05). There was poor discriminatory ability for cobalt for pseudotumour formation. Conclusion This prospective study reports a minimum ten-year follow-up of large-head MoM THA. Revision rates are high, with the main reason being the sequelae of pseudotumour formation, which were rarely observed after five years of implantation. Blood ion measurements show limited discriminatory capacity in diagnosing pseudotumour formation. Our results evidence that an early comprehensive follow-up strategy is essential for MoM THA to promptly identify and manage early complications and revise on time. After ten years follow-up, we do not recommend continuing routine CT scanning or whole cobalt blood measurements, but instead enrolling these patients in routine follow-up protocols for THA. Cite this article: Bone Jt Open 2022;3(1):61–67.
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Affiliation(s)
- Christiaan P. van Lingen
- Department of Orthopaedic Surgery and Traumatology, Medisch Spectrum Twente, Enschede, Overijssel, Netherlands
| | - Harmen B. Ettema
- Department of Orthopaedic Surgery and Traumatology, Isala, Zwolle, Overijssel, Netherlands
| | - Bart H. Bosker
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, Gelderland, Netherlands
| | - Cees C. P. M. Verheyen
- Department of Orthopaedic Surgery and Traumatology, Isala, Zwolle, Overijssel, Netherlands
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Best Practices: Best Imaging Modality for Surveillance of Metal-on-Metal Hip Arthroplasty. AJR Am J Roentgenol 2020; 216:311-317. [PMID: 33325734 DOI: 10.2214/ajr.19.22344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Metal-on-metal hip arthroplasty has been shown to result in soft-tissue complications in some patients, making revision surgery necessary. Imaging is critical in the detection and surveillance of soft-tissue complications, which are collectively termed adverse reaction to metal debris (ARMD) and adverse local tissue reaction. Studies have investigated the use of ultrasound, MRI, and CT for detecting ARMD, and each modality has advantages and disadvantages. This article provides evidence-based recommendations for imaging surveillance of ARMD. CONCLUSION. Compared with ultrasound, MRI has been found to be a better imaging modality for surveillance of ARMD. In addition, MRI is not operator dependent, allows visualization of soft-tissue details, and allows more consistent measurement of fluid collections on follow-up examinations. Limitations of ultrasound include operator skill, the inability to visualize osseous structures, and the challenge of visualizing posterior soft tissues for synovitis and fluid collections in larger patients. Finally, CT is only useful for focused evaluation of osteolysis or periprosthetic fracture.
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van der Veen HC, Reininga IHF, Zijlstra WP, Boomsma MF, Bulstra SK, van Raay JJAM. Pseudotumours, cobalt and clinical outcome in small head metal-on-metal versus conventional metal-on-polyethylene total hip arthroplasty. Hip Int 2020; 30:56-63. [PMID: 30838896 PMCID: PMC6974777 DOI: 10.1177/1120700019832877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Metal-on-metal total hip arthroplasty (MoM THA) is associated with the formation of pseudotumours. Studies mainly concern pseudotumour formation in large head MoM THA. We performed a long-term follow-up study, comparing pseudotumour incidence in small head metal-on-metal (SHMoM) THA with conventional metal-on-polyethylene (MoP) THA. Predisposing factors to pseudotumour formation were assessed. METHODS From a previous randomised controlled trial comparing SHMoM (28 mm) cemented THA with conventional MoP cemented THA, patients were screened using a standardised CT protocol for the presence of pseudotumours. Serum cobalt levels and functional outcome were assessed. RESULTS 56 patients (33 MoP and 23 MoM) were recruited after mean follow-up of 13.4 years (SD 0.5). The incidence of pseudotumours was 1 (5%) in the SHMoM THA cohort and 3 (9%) in the MoP THA cohort. Prosthesis survival was 96% for both SHMoM and MoP THAs. Serum cobalt levels did not exceed acceptable clinical values (<5 µg/L) whereas no differences in cobalt levels were detected at follow-up between both groups. Oxford and Harris Hip Scores were good and did not differ between SHMoM and MoP THA. CONCLUSIONS This long-term follow-up study shows a low incidence of pseudotumour formation and good functional outcome in cemented head-taper matched SHMoM and MoP THA.
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Affiliation(s)
- Hugo C van der Veen
- Department of Orthopaedic Surgery,
University Medical Centre Groningen, University of Groningen, The Netherlands,Hugo C van der Veen, Department of
Orthopaedic Surgery, University Medical Centre Groningen, University of
Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Inge HF Reininga
- Department of Traumasurgery, University
of Groningen, University Medical Centre Groningen, The Netherlands
| | - Wierd P Zijlstra
- Department of Orthopaedic Surgery,
Medical Centre Leeuwarden, The Netherlands
| | | | - Sjoerd K Bulstra
- Department of Orthopaedic Surgery,
University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Jos JAM van Raay
- Department of Orthopaedic Surgery,
Martini Hospital Groningen, The Netherlands
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Li J, Zhou K, Chen Z, Wang D, Zhou Z, Kang P, Shen B, Yang J, Pei F. [Mid- and long-term effectiveness and failure causes analysis of large-head metal-on-metal total hip arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:144-149. [PMID: 29786243 PMCID: PMC8458156 DOI: 10.7507/1002-1892.201605122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 01/05/2017] [Indexed: 02/05/2023]
Abstract
Objective To explore the effectiveness and failure causes of large-head metal-on-metal total hip arthroplasty (large-head MoM THA). Methods Between March 2007 and May 2010, 159 patients (183 hips) underwent large-head MoM THA, and the clinical data were analyzed. There were 50 females (54 hips) and 109 males (129 hips) with an average age of 50 years (range, 20-78 years). Single hip was involved in 135 cases (left hip in 69 cases and right hip in 66 cases) and double hips in 24 cases. The causes included femoral head necrosis in 74 cases (93 hips), Legg-Calve-Perthes in 1 case (1 hip), osteoarthritis in 18 cases (19 hips), developmental dysplasia of the hip in 17 cases (18 hips), osteoarthritis after hip septic infection in 8 cases (8 hips), traumatic arthritis of the hip in 6 cases (6 hips), femoral neck fracture in 17 cases (17 hips), ankylosing spondylitis in 8 cases (11 hips), rheumatoid arthritis of hip in 9 cases (9 hips), and adult onset Still's disease in 1 case (1 hip). Before operation, visual analogue scale (VAS) was 6.59±0.87; Harris score was 45.99±8.07. Results Healing of incisions by first intention was achieved, and no operative complication occurred. The patients were followed up 1.2-8.2 years (mean, 6.1 years). Implant failure was observed in 15 cases (17 hips), and the 5-year survival rate of large-head MoM THA was 91.80% (168/183). The causes of implant failure after THA were inflammatory pseudotumor in 4 cases (4 hips), acetabular aseptic loosening in 3 cases (3 hips), osteolysis in 4 cases (5 hips), acetabular aseptic loosening combined with inflammatory pseudotumor in 3 cases (3 hips), and functional disused in 1 case (2 hips). Of them, 9 cases (11 hips) did not receive revision surgery for various reasons, while 6 cases (6 hips) underwent revision surgery at 1.2-5.4 years (mean 3.7 years) after large-head MoM THA. At last follow-up, VAS and Harris score were 1.72±1.48 and 81.37±10.75 respectively, showing significant differences when compared with preoperative scores ( t=-35.547, P=0.000; t=33.823, P=0.000). The function was excellent in 44 hips, good in 89 hips, fair in 33 hips, and poor in 17 hips. Conclusion Large-head MoM THA has a high revision rate during mid- and long-term follow-up because of inflammatory pseudotumor, acetabular aseptic loosening, and osteolysis. Early revision can effectively improve the function of the hip and improve patients'quality of life.
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Affiliation(s)
- Jinlong Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Kai Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zhi Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Duan Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
| | - Pengde Kang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Bin Shen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jing Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuxing Pei
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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van Lingen CP, Zagra LM, Ettema HB, Verheyen CC. Sequelae of large-head metal-on-metal hip arthroplasties: Current status and future prospects. EFORT Open Rev 2016; 1:345-353. [PMID: 28461912 PMCID: PMC5367524 DOI: 10.1302/2058-5241.1.160014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Large-head metal-on-metal (MoM) bearings were re-popularised in the late 1990s with the introduction of modern hip resurfacing (HR), followed closely by large metal head total hip arthroplasty (THA). A worldwide increase in the use of MoM hip arthroplasty subsequently saw a sharp decline, due to serious complications.MoM was rapidly adopted in the early 2000s until medical device alerts were issued by government regulatory agencies and national and international organisations, leading to post-marketing surveillance and discontinuation of these implants.Guidelines for MoM hip implant follow-up differ considerably between regulatory authorities worldwide; this can in part be attributed to missing or conflicting evidence.The authors consider that the use of large-head MoM THA should be discontinued. MoM HR should be approached with caution and, when considered, should be used only in patients who meet all of the recommended selection criteria, which limits its indications considerably.The phased introduction of new prostheses should be mandatory in future. Close monitoring of outcomes and long-term follow-up is also necessary for the introduction of new prostheses. Cite this article: van Lingen CP, Zagra LM, Ettema HB, Verheyen CC. Sequelae of large-head metal-on-metal hip arthroplasties: current status and future prospects. EFORT Open Rev 2016;1:345-353. DOI: 10.1302/2058-5241.1.160014.
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Affiliation(s)
| | | | - Harmen B. Ettema
- Isala Clinics, Department of Orthopaedic Surgery and Traumatology, Zwolle, The Netherlands
| | - Cees C. Verheyen
- Isala Clinics, Department of Orthopaedic Surgery and Traumatology, Zwolle, The Netherlands
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Blum A, Gondim-Teixeira P, Gabiache E, Roche O, Sirveaux F, Olivier P, Coudane H, Raymond A, Louis M, Grandhaye M, Meyer JB, Mainard D, Molé D. Developments in imaging methods used in hip arthroplasty: A diagnostic algorithm. Diagn Interv Imaging 2016; 97:735-47. [PMID: 27452630 DOI: 10.1016/j.diii.2016.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/01/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Several imaging modalities can be used to diagnose complications of hip prosthesis placement. Despite progress in these imaging techniques, there are, as yet, no guidelines as to their respective indications. METHODS We formed a panel of experts in fields related to prosthesis imaging (radiology, nuclear medicine, orthopedic surgery) and conducted a review of the literature to determine the value of each modality for diagnosing complications following hip replacement. RESULTS Few recent studies have investigated the benefits related to the use of the latest technical developments, and studies comparing different methods are extremely rare. CONCLUSIONS We have developed a diagnostic tree based on the characteristics of each imaging technique and recommend its use. Computed topography was found to be the most versatile and cost-effective imaging solution and therefore a key tool for diagnosing the complications of hip replacement surgery.
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Affiliation(s)
- A Blum
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - P Gondim-Teixeira
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - E Gabiache
- Service de médecine nucléaire, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
| | - O Roche
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - F Sirveaux
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - P Olivier
- Service de médecine nucléaire, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
| | - H Coudane
- Chirurgie traumatologique et arthroscopique de l'appareil locomoteur (ATOL), CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | | | - A Raymond
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - M Louis
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - M Grandhaye
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - J-B Meyer
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - D Mainard
- Chirurgie orthopédique et traumatologique (COT), CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - D Molé
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
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Davis DL, Morrison JJ. Hip Arthroplasty Pseudotumors: Pathogenesis, Imaging, and Clinical Decision Making. J Clin Imaging Sci 2016; 6:17. [PMID: 27195183 PMCID: PMC4863402 DOI: 10.4103/2156-7514.181493] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/14/2016] [Indexed: 12/13/2022] Open
Abstract
Pseudotumors are a complication of hip arthroplasty. The goal of this article is to review the clinical presentation, pathogenesis, histology, and the role of diagnostic imaging in clinical decision making for treatment, and surveillance of pseudotumors. We will discuss the multimodal imaging appearances, differential diagnosis, associated complications, treatment, and prognosis of pseudotumors, as an aid to the assessment of orthopedic prostheses at the hip.
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Affiliation(s)
- Derik L Davis
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James J Morrison
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
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Quantitative analysis of orthopedic metal artefact reduction in 64-slice computed tomography scans in large head metal-on-metal total hip replacement, a phantom study. SPRINGERPLUS 2016; 5:405. [PMID: 27047731 PMCID: PMC4818838 DOI: 10.1186/s40064-016-2006-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/15/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE Quantification of the effect of O-MAR on decreasing metal artefacts caused by large head metal on metal total hip arthroplasty (MoM THA) in a dedicated phantom setup of the hip. BACKGROUND Pathological reactions of the hip capsule on Computed tomography (CT) can be difficult to diagnose due to different metal artefacts. The O-MAR algorithm deploys an iterative loop where the metal sinogram is identified, extracted, and subsequently serves as a mask to correct the measured sinogram. Main goal of this study is to quantify the ability of the O-MAR technique to correct deviation in medullary bone attenuation caused by streak artefacts from the large-head MoM THA embedded in a phantom. Secondary goal is to evaluate the influence of O-MAR on CNR. METHODS The phantom was designed as a Perspex box (PMMA) containing water and a supplementary MOM THA surrounded by Perspex columns comprising calibrated calcium pellets. Each column contains 200 mg of hydroxyapatite/calcium carbonate to simulate healthy bone tissue. Scans were obtained with and without a MoM THA at different dose levels. Different reconstructions were made with filter A, iDose(4) level 5 and with and without O-MAR. The scans without the prosthesis were used as the baseline. Information about the attenuation in Hounsfield units, image noise in standard deviation within the ROI's were extracted and the CNR was calculated. RESULTS Pellet L0 and R0 (proximal of the MoM THA) were defined as reference, lacking any disturbance by metal artefacts; L5, L6 and L8 were respectively visually categorized as 'light' 'medium' and 'heavy disturbance'. Significant improvements in attenuation deviation caused by metal artefact were 43, 68 and 32 %, for respectively pellet L5, L6 and L8 (p < 0.001). Significant CNR improvements were present for L5 and L6 and were respectively 72 and 52 % (p < 0.001). O-MAR showed no improvement on CNR for L8. CONCLUSION This phantom study significantly increases image quality by the use of O-MAR in the presence of metal artefacts by significantly reducing metal artefacts subsequently and increasing CNR on a 64 slice CT system in light and medium disturbance of the image.
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Boomsma MF, Slouwerhof I, van Lingen C, Pakvis DFM, van Dalen JA, Edens MA, Ettema HB, Verheyen CCPM, Maas M. CT-based quantification of bone stock in large head metal-on-metal unilateral total hip replacements. Eur J Radiol 2016; 85:760-3. [PMID: 26971420 DOI: 10.1016/j.ejrad.2016.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/06/2015] [Accepted: 01/21/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore ipsilateral and contralateral acetabular roof bone stock density in unilateral large head MoM THA whether there is a significant lower acetabular bone stock in the hip with a metal-on-metal (MoM) total hip replacement compared to the contralateral side. Second part of this study is to examine if there are any associates with regard to potential bone stock density difference. MATERIALS & METHODS A database of 317 patients with unilateral metal-on-metal (MoM) total hip replacements was set up retrospectively for this study. On computed tomography scans, conducted after a relative short in situ time period averaging 2.8 years, regions-of-interests were drawn in the trabecular bone of the acetabulum to measure average Hounsfield Units (HU). HU differences were calculated and tested by Wilcoxon signed-rank test. Univariate analysis was conducted to examine associates of potential bone loss. RESULTS In a population of 317 patients (156 male, 161 female) with an average age of 61.9 ± 7.8, the median HU on the side of the MoM replacement was 123.3 (7.6-375.4). On the contralateral side, median HU was 144.7 (-0.4 to 332.8). The median HU difference was 21.4 after a mean post-operative in situ time of 2.8 years. The Wilcoxon signed-rank test proved a significant difference (p<0.001). Univariate analyses show that the in situ time of the MoM THA has a significant correlation with the bone density difference. CONCLUSION Results show a significant lower bone density at the acetabular roof at the side of the prosthesis compared with the contralateral side after short in situ time of the MoM THA in patients with unilateral MoM total hip replacements. In our patient population, the in situ time showed a significant association with the acetabular bone density difference. As acetabular roof bone stock measurements are feasible and show temporal decline this could become an important parameter to be used in orthopedic decision making for revision surgery.
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Affiliation(s)
- Martijn F Boomsma
- Department of Radiology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
| | - Inge Slouwerhof
- Department of Radiology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
| | - Christiaan van Lingen
- Department of Orthopedic surgery and Traumatology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
| | - Dean F M Pakvis
- Orthopedic Centre OCON, Geerdinksweg 141 7555 DL, Almelo/Hengelo, The Netherlands.
| | - Jorn A van Dalen
- Department of Radiology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
| | - Mireille A Edens
- Department of Innovation and Science, Isala, Dokter van Deenweg 1, 8025 BP Zwolle, The Netherlands.
| | - Harmen B Ettema
- Department of Orthopedic surgery and Traumatology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
| | - Cees C P M Verheyen
- Department of Orthopedic surgery and Traumatology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
| | - Mario Maas
- Department of Radiology, AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Boomsma MF, Slouwerhof I, van Dalen JA, Edens MA, Mueller D, Milles J, Maas M. Use of internal references for assessing CT density measurements of the pelvis as replacement for use of an external phantom. Skeletal Radiol 2015; 44:1597-602. [PMID: 26173417 DOI: 10.1007/s00256-015-2206-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/04/2015] [Accepted: 06/16/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this research is to study the use of an internal reference standard for fat- and muscle as a replacement for an external reference standard with a phantom. By using a phantomless internal reference standard, Hounsfield unit (HU) measurements of various tissues can potentially be assessed in patients with a CT scan of the pelvis without an added phantom at time of CT acquisition. This paves the way for development of a tool for quantification of the change in tissue density in one patient over time and between patients. This could make every CT scan made without contrast available for research purposes. MATERIALS AND METHODS Fifty patients with unilateral metal-on-metal total hip replacements, scanned together with a calibration reference phantom used in bone mineral density measurements, were included in this study. On computed tomography scans of the pelvis without the use of intravenous iodine contrast, reference values for fat and muscle were measured in the phantom as well as within the patient's body. The conformity between the references was examined with the intra-class correlation coefficient. RESULTS The mean HU (± SD) of reference values for fat for the internal- and phantom references were -91.5 (±7.0) and -90.9 (±7.8), respectively. For muscle, the mean HU (± SD) for the internal- and phantom references were 59.2 (±6.2) and 60.0 (±7.2), respectively. The intra-class correlation coefficients for fat and muscle were 0.90 and 0.84 respectively and show excellent agreement between the phantom and internal references. CONCLUSION Internal references can be used with similar accuracy as references from an external phantom. There is no need to use an external phantom to asses CT density measurements of body tissue.
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Affiliation(s)
| | - Inge Slouwerhof
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Jorn A van Dalen
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Mireille A Edens
- Department of Innovation and Science, Isala Hospital, Zwolle, The Netherlands
| | | | - Julien Milles
- Philips Healthcare Benelux, Eindhoven, The Netherlands
| | - Mario Maas
- Department of Radiology, AMC, Amsterdam, The Netherlands
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