A Study in Hipness
Radiology Today featured an update on HSS research on MRI & adverse tissue reactions in asymptomatic hip patients and included insight from authors Hollis G. Potter, MD, Chairman, Department of Radiology and Imaging, and Matthew F. Koff, PhD, assistant scientist at HSS.
The article also featured commentary on the clinical implications from Mathias P. Bostrom, MD, chief of the Adult Reconstruction and Joint Replacement Service at HSS, and Geoffrey H. Westrich, MD, hip and knee surgeon at HSS.
According to Dr. Potter, “At the end of the day, we can’t cure osteoarthritis, but we can treat it. As the population gets older, more people will require hip and knee implants.”
She continued that joint replacements also are going into younger people, many of whom lead active lifestyles, “which means the demands on the implants are greater. Noting the newer materials used in hip replacements are considered safer. However, some patients still have adverse reactions.
According to Dr. Bostrom, “Where you have dissimilar materials touching each other, you could have problems.”
Dr. Koff explained that patients’ genetic makeup typically determines whether they will have an adverse tissue reaction, “but, unfortunately, there’s no way to predict whether someone is genetically predisposed.”
Dr. Potter and colleagues have been working on software that makes MRI the go-to tool to detect adverse tissue reactions in total hip arthroplasty and hip resurfacing, which is an alternative to completely replacing the hip.
Drs. Potter, Koff, and colleagues published a December 2021 study in Clinical Orthopaedics and Related Research finding that MRI identifies adverse tissue reactions in asymptomatic individuals after hip resurfacing arthroplasty. Previous studies have been limited to metal-on-metal implants.
The HSS researchers determined MRI identified adverse local tissue reactions in 25% of patients who had hip resurfacing arthroplasty. Dr. Potter said the finding was surprising because the patients who had reactions had symptoms similar to, or even less severe than, patients with ceramic-on-polyethylene and metal-on-polyethylene total hip replacements.
“We found that patients can be completely asymptomatic and have high-functioning hip scores while harboring reactions that could start to destroy the soft tissues around the hip,” Dr. Potter noted. “If you have an adverse tissue reaction, and it goes unchecked, it could destroy the tissues in half your pelvis.”
Dr. Koff added that the benefit of finding adverse reactions early cannot be underestimated. “If a patient has an adverse tissue reaction and you don’t find it early, if you have to do a revision, the revision surgery is going to take much longer,” he says. “It’s a lot more challenging, the recovery is longer, and there is a greater cost associated with every aspect of it, including the rehabilitation.”
Dr. Bostrom noted the HSS study is cutting edge and groundbreaking. “It will revolutionize the way we assess total joint replacement. I don’t think you can understate that.”
Dr. Westrich agreed that it would be worth following high-risk hip replacement patients with MRI but to exercise caution. “It would be extremely costly for the hospital, the patient, and the insurance carrier, and, in this era of cost containment, we have to pick carefully what tests we’re going to have. If the hip has no cobalt or chrome, that’s not the patient I would order an MRI for,” he said.
Dr. Westrich underscored that not all radiologists are able to use MRI to evaluate hip implants as successfully as Dr. Potter and those at HSS. “With MRIs, it’s very dependent on who’s doing it and whether they are dedicated to figuring out the best methods of doing metal suppression MRIs,” he added.
He continued, “MRI quality and technique vary tremendously from location to location. At our institution, we have the highest-resolution MRIs, the most powerful magnets, and the latest technology.”
Read the full article at Radiologytoday.net. The article also appeared as the cover story in the January/February print issue of the magazine.