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Skeletal Radiology
Published in: Skeletal Radiology 8/2018

Open Access 01-08-2018 | Scientific Article

Pseudotumor in metal-on-metal hip arthroplasty: a comparison study of three grading systems with MRI

Authors: C. Smeekes, B. J. M. Schouten, M. Nix, B. F. Ongkiehong, R. Wolterbeek, B. C. H. van der Wal, R. G. H. H. Nelissen

Published in: Skeletal Radiology | Issue 8/2018

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Abstract

Objective

Pseudotumors, a well-known complication of metal-on-metal total hip arthroplasty (MoM THA), are well identified on metal artifact-reducing sequences magnetic resonance imaging (MARS-MRI). Several MRI grading systems are described in the orthopedic literature, but their validity is unknown in large clinical studies. Our study was undertaken to describe the classification of pseudotumors in a preselected cohort divided into high- and low-risk patients, using three pseudotumor grading systems applied on MARS-MRI, and to determine the interobserver reliability of the grading systems.

Patients and methods

A retrospective study was performed on 377 consecutive patients (240 MRI scans) treated with an M2a-38 and Taperloc stem combination (Biomet, Warsaw, IN, USA). Patients were divided into a high-risk and a low-risk group based on previous published risk factors. Two observers determined the presence of pseudotumors using three different pseudotumor grading systems for classifying MARS-MRI results.

Results

The prevalence of pseudotumors as determined with MARS-MRI was 59% in our high-risk group, 0% in the low-risk group and 43% in the control group. Serum cobalt values were increased in the high-risk group. The kappa values of the Anderson, Hauptfleisch and Matthies grading system scores were 0.43, 0.44, and 0.49 respectively.

Conclusions

High-risk patients are at a high risk for pseudotumor development. No pseudotumor development was found in low-risk patients. Interobserver reliability scored best with the Matthies system, but all three grading systems showed only a moderate agreement.
Literature
1.
Smith AJ, Dieppe P, Vernon K, Porter M, Blom AW. 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.CrossRefPubMed
2.
Hart AJ, Sabah SA, Bandi AS, Maggiore P, Tarassoli P, Sampson B, et al. Sensitivity and specificity of blood cobalt and chromium metal ions for predicting failure of metal-on-metal hip replacement. J Bone Joint Surg Br. 2011;93(10):1308–13.CrossRefPubMed
3.
Hauptfleisch J, Pandit H, Grammatopoulos G, Gill HS, Murray DW, Ostlere S. A MRI classification of periprosthetic soft tissue masses (pseudotumours) associated with metal-on-metal resurfacing hip arthroplasty. Skeletal Radiol. 2012;41(2):149–55.CrossRefPubMed
4.
Bisseling P, de Wit BW, Hol AM, van Gorp MJ, van Kampen A, van Susante JL. Similar incidence of periprosthetic fluid collections after ceramic-on-polyethylene total hip arthroplasties and metal-on-metal resurfacing arthroplasties: results of a screening metal artefact reduction sequence-MRI study. Bone Joint J. 2015;97-B(9):1175–82.CrossRefPubMed
5.
Nikolaou VS, Petit A, Khoury V, Blain-Pare E, Zukor DJ, Huk OL, et al. Magnetic resonance imaging of painful metal-on-metal total hip replacement. Eur J Orthop Surg Traumatol. 2015;25(2):313–9.CrossRefPubMed
6.
Abdel-Hamid H, Miles J, Carrington RW, Hart A, Loh A, Skinner JA. Combined vascular and orthopaedic approach for a pseudotumor causing deep vein thrombosis after metal-on-metal hip resurfacing arthroplasty. Case Rep Orthop. 2015;2015:926263.PubMedPubMedCentral
7.
Clayton RA, Beggs I, Salter DM, Grant MH, Patton JT, Porter DE. Inflammatory pseudotumor associated with femoral nerve palsy following metal-on-metal resurfacing of the hip. A case report. J Bone Joint Surg Am. 2008;90(9):1988–93.CrossRefPubMed
8.
Fischer SR, Christ DJ, Roehr BA. Sciatic neuropathy secondary to total hip arthroplasty wear debris. J Arthroplast. 1999;14(6):771–4.CrossRef
9.
Fokter SK, Repse-Fokter A, Takac I. Case report: femoral neuropathy secondary to total hip arthroplasty wear debris. Clin Orthop Relat Res. 2009ss;467(11):3032–5.CrossRefPubMedPubMedCentral
10.
Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Maas M, Verheyen CC. High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. J Bone Joint Surg Br. 2012;94(6):755–61.CrossRefPubMed
11.
Keegan GM, Learmonth ID, Case CP. A systematic comparison of the actual, potential, and theoretical health effects of cobalt and chromium exposures from industry and surgical implants. Crit Rev Toxicol. 2008;38(8):645–74.CrossRefPubMed
12.
Langton DJ, Jameson SS, Joyce TJ, Hallab NJ, Natu S, Nargol AV. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: a consequence of excess wear. J Bone Joint Surg Br. 2010;92(1):38–46.CrossRefPubMed
13.
Moroni A, Savarino L, Hoque M, Cadossi M, Baldini N. Do ion levels in hip resurfacing differ from metal-on-metal THA at midterm? Clin Orthop Relat Res. 2011;469(1):180–7.CrossRefPubMed
14.
Chang EY, McAnally JL, Van Horne JR, Statum S, Wolfson T, Gamst A, et al. Metal-on-metal total hip arthroplasty: do symptoms correlate with MR imaging findings? Radiology. 2012;265(3):848–57.CrossRefPubMed
15.
Hart AJ, Muirhead-Allwood S, Porter M, Matthies A, Ilo K, Maggiore P, et al. Which factors determine the wear rate of large-diameter metal-on-metal hip replacements? Multivariate analysis of two hundred and seventy-six components. J Bone Joint Surg Am. 2013;95(8):678–85.CrossRefPubMed
16.
Anderson H, Toms AP, Cahir JG, Goodwin RW, Wimhurst J, Nolan JF. Grading the severity of soft tissue changes associated with metal-on-metal hip replacements: reliability of an MR grading system. Skeletal Radiol. 2011;40(3):303–7.CrossRefPubMed
17.
Matthies AK, Skinner JA, Osmani H, Henckel J, Hart AJ. Pseudotumors are common in well-positioned low-wearing metal-on-metal hips. Clin Orthop Relat Res. 2012;470(7):1895–906.CrossRefPubMed
18.
Van der Weegen W, Brakel K, Horn RJ, Wullems JA, Das HP, Pilot P, et al. Comparison of different pseudotumor grading systems in a single cohort of metal-on-metal hip arthroplasty patients. Skeletal Radiol. 2014;43(2):149–55.
19.
Bisseling P, de Wit BW, Hol AM, van Gorp MJ, van K A, van Susante JL. Similar incidence of periprosthetic fluid collections after ceramic-on-polyethylene total hip arthroplasties and metal-on-metal resurfacing arthroplasties: results of a screening metal artefact reduction sequence-MRI study. Bone Joint J. 2015;97-B(9):1175–82.CrossRefPubMed
20.
Nawabi DH, Gold S, Lyman S, Fields K, Padgett DE, Potter HG. MRI predicts ALVAL and tissue damage in metal-on-metal hip arthroplasty. Clin Orthop Relat Res. 2014;472(2):471–81.CrossRefPubMed
21.
Reito A, Elo P, Puolakka T, Pajamaki J, Nieminen J, Eskelinen A. Repeated magnetic resonance imaging in 154 hips with large-diameter metal-on-metal hip replacement. Acta Orthop. 2014;85(6):570–6.CrossRefPubMedPubMedCentral
22.
Smeekes C, Ongkiehong B, van der Wal B, Wolterbeek R, Henseler JF, Nelissen R. Large fixed-size metal-on-metal total hip arthroplasty: higher serum metal ion levels in patients with pain. Int Orthop. 2015;39(4):631–8. CrossRefPubMed
23.
Goulle JP, Mahieu L, Castermant J, Neveu N, Bonneau L, Laine G, et al. Metal and metalloid multi-elementary ICP-MS validation in whole blood, plasma, urine and hair. Reference values. Forensic Sci Int. 2005;153(1):39–44.CrossRefPubMed
24.
Langton DJ, Joyce TJ, Jameson SS, Lord J, Van OM, Holland JP, et al. Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear. J Bone Joint Surg Br. 2011;93(2):164–71.CrossRefPubMed
25.
Reito A, Elo P, Nieminen J, Puolakka T, Eskelinen A. Gluteal muscle fatty atrophy is not associated with elevated blood metal ions or pseudotumors in patients with a unilateral metal-on-metal hip replacement. Acta Orthop. 2016;87(1):29–35.CrossRefPubMed
26.
Bayley N, Khan H, Grosso P, Hupel T, Stevens D, Snider M, et al. What are the predictors and prevalence of pseudotumor and elevated metal ions after large-diameter metal-on-metal THA? Clin Orthop Relat Res. 2015;473(2):477–84.CrossRefPubMed
27.
Bosker BH, Ettema HB. Van RM, Boomsma MF, Kollen BJ, Maas M, et al. Pseudotumor formation and serum ions after large head metal-on-metal stemmed total hip replacement. Risk factors, time course and revisions in 706 hips. Arch Orthop Trauma Surg. 2015;135(3):417–25.CrossRefPubMed
28.
Hart AJ, Satchithananda K, Liddle AD, Sabah SA, McRobbie D, Henckel J, et al. 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.CrossRefPubMed
29.
Williams DH, Greidanus NV, Masri BA, Duncan CP, Garbuz DS. Prevalence of pseudotumor in asymptomatic patients after metal-on-metal hip arthroplasty. J Bone Joint Surg Am. 2011;93(23):2164–71.CrossRefPubMed
30.
Nikolajsen L, Brandsborg B, Lucht U, Jensen TS, Kehlet H. Chronic pain following total hip arthroplasty: a nationwide questionnaire study. Acta Anaesthesiol Scand. 2006;50(4):495–500.CrossRefPubMed
31.
Gill HS, Grammatopoulos G, Adshead S, Tsialogiannis E, Tsiridis E. Molecular and immune toxicity of CoCr nanoparticles in MoM hip arthroplasty. Trends Mol Med. 2012;18(3):145–55.CrossRefPubMed
32.
Liow MH, Dimitriou D, Tsai TY, Kwon YM. Preoperative risk factors associated with poor outcomes of revision surgery for "pseudotumors" in patients with metal-on-metal hip arthroplasty. J Arthroplast. 2016;31(12):2835–42.CrossRef
33.
De Smet KA, Van Der Straeten C, Van O M, Doubi R, Backers K, Grammatopoulos G. Revisions of metal-on-metal hip resurfacing: lessons learned and improved outcome. Orthop Clin North Am. 2011;42(2):259–69. ixCrossRefPubMed
34.
Grammatopoulos G, Pandit H, Kwon YM, Gundle R, McLardy-Smith P, Beard DJ, et al. Hip resurfacings revised for inflammatory pseudotumour have a poor outcome. J Bone Joint Surg Br. 2009;91(8):1019–24.CrossRefPubMed
35.
Munro JT, Masri BA, Duncan CP, Garbuz DS. High complication rate after revision of large-head metal-on-metal total hip arthroplasty. Clin Orthop Relat Res. 2014;472(2):523–8.CrossRefPubMed
36.
Mohaddes M, Cnudde P, Rolfson O, Wall A, Karrholm J. Use of dual-mobility cup in revision hip arthroplasty reduces the risk for further dislocation: analysis of seven hundred and ninety one first-time revisions performed due to dislocation, reported to the Swedish Hip Arthroplasty Register. Int Orthop. 2017;41(3):583–8
Metadata
Title
Pseudotumor in metal-on-metal hip arthroplasty: a comparison study of three grading systems with MRI
Authors
C. Smeekes
B. J. M. Schouten
M. Nix
B. F. Ongkiehong
R. Wolterbeek
B. C. H. van der Wal
R. G. H. H. Nelissen
Publication date
01-08-2018
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 8/2018
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-018-2873-0

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