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.

The study found that patients with unilateral hip resurfacing arthroplasty had higher cobalt and chromium serum ion levels than those with unilateral ceramic on polyethylene bearings. Additionally, more patients who had a hip resurfacing arthroplasty developed adverse local tissue reactions (ALTR) or metallosis on MRI than did patients who got ceramic on polyethylene bearings.

Dr. Potter said, “While the majority of these high functioning individuals with HRA [hip resurfacing arthroplasty] had no adverse local tissue reaction, longitudinal yearly evaluation disclosed that more patients who received a HRA developed ALTR or metallosis on MRI than patients who had ceramic on polyethylene bearings (hazard ratio 4.8 (95% CI 1.2-18.4); p=0.02).”

Dr. Su explained, “This study highlights the value in using MRI to evaluate patients with metal-on-metal hip resurfacing. It demonstrates that metal levels or clinical performance do not always correlate with MRI findings of adverse local tissue reaction, and therefore all of this information is valuable in the evaluation of such a patient. Just as I would not recommend the sole use of metal ion levels in deciding management of a patient, similarly, I would not utilize MR information alone to make decisions. All of the information—clinical picture, metal ions, and MR information—should be used in concert in managing the patient with a metal-on-metal hip resurfacing."

Read the full article at Ryortho.com.

The study found that MRI effectively tracks soft-tissue complications in patients who have undergone hip resurfacing arthroplasty or total hip replacement and also suggest the use of MRI to be included as part of routine follow-up protocol, as an annual clinical assessment dependent on survey or blood metal ion testing alone may not detect complications.

Dr. Potter said, “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. This finding is important because tissue reactions typically worsen over time. Delayed detection results in unnecessary pain, longer and more complicated revision operations and more challenging recoveries."

Read the full article at Auntminnie.com. Additional coverage: Orthospinenews.com.