What are the guidelines for the surgical and nonsurgical treatment of periprosthetic osteolysis?

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Abstract

[Indexed for MEDLINE] 10. J Bone Joint Surg Am. 2004 Sep;86(9):1947-54. doi: 10.2106/00004623-200409000-00013. Magnetic resonance imaging after total hip arthroplasty: evaluation of periprosthetic soft tissue. Potter HG(1), Nestor BJ, Sofka CM, Ho ST, Peters LE, Salvati EA. Author information: (1)Division of Magnetic Resonance Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. potterh@hss.edu BACKGROUND: The evaluation of periprosthetic osteolysis in patients who have had a total hip arthroplasty is challenging, and traditional imaging techniques, including magnetic resonance imaging and computerized tomography, are limited by metallic artifact. The purpose of the present study was to investigate the use of modified magnetic resonance imaging techniques involving commercially available software to visualize periprosthetic soft tissues, to define the bone-implant interface, and to detect the location and extent of osteolysis. METHODS: Twenty-eight hips in twenty-seven patients were examined to assess the extent of osteolysis (nineteen hips), enigmatic pain (five), heterotopic ossification (two), suspected tumor (one), or femoral nerve palsy (one). The results were correlated with conventional radiographic findings as well as with intraoperative findings (when available). RESULTS: Magnetic resonance imaging demonstrated the bone-implant interface and the surrounding soft-tissue envelope in all hips. Radiographs consistently underestimated the extent and location of acetabular osteolysis when compared with magnetic resonance imaging. Magnetic resonance imaging also disclosed radiographically occult extraosseous soft-tissue deposits that were similar in signal intensity to areas of osteolysis, demonstrated the relationship of these deposits to adjacent neurovascular structures, and allowed further visualization of hypertrophic synovial deposits that accompanied the bone resorption in twenty-five of the twenty-eight hips. CONCLUSIONS: Magnetic resonance imaging is effective for the assessment of the periprosthetic soft tissues in patients who have had a total hip arthroplasty. While not indicated for every patient who has pain at the site of an arthroplasty, these techniques can be effective for the evaluation of the surrounding soft-tissue envelope as well as intracapsular synovial deposits and are more effective than radiographs for the detection and evaluation of osteolysis, thus aiding in clinical management. DOI: 10.2106/00004623-200409000-00013