Abstract:
AIM:To perform a retrospective review of all the conventional radiographic and magnetic resonance imaging (MRI) studies performed in patients with early postoperative pain following cobalt-chrome metal-on-metal total hip arthroplasty. METHODS:A retrospective review of the radiology, surgical findings and histology in nineteen patients who had undergone a total of 20 hip arthroplasties using a cobalt-chromium on cobalt-chromium alloy prosthesis was undertaken. RESULTS:Measures of implant placement on the immediate postoperative radiographs were all within the normal ranges (n=20). Where more than one postoperative radiograph was available statistical analysis revealed no evidence of progressive change before the MRI examination (14). The median postoperative time to MRI was 35 months (range 11-63 months). Abnormalities were demonstrated using MRI in all symptomatic hips (n=20). These comprised: periprosthetic fluid collections (20), which were isointense to muscle on T1-weighted images in 19 cases and hyperintense on T2-weighted images in 18 cases, periprosthetic bone marrow oedema (n=6), muscle oedema (n=4), avulsion of the gluteus minimus and medius tendons (n=5), atrophy of piriformis (n=15) and obturator internus (n=17), and fracture of the medial calcar (n=1). Operative findings in patients who had undergone revision surgery (n=15) included: fluid-filled cavities (n=11), soft tissue necrosis (n=8), gluteal tendon avulsion (n=5), proximal femoral diaphyseal necrosis (n=4), and pitting and corrosion of the femoral stems (n=8), which were, in all cases, firmly fixed to the cement mantle. Histology revealed viable tissue in six hips with necrosis (n=12) and fibrin deposition (n=15) being the predominate findings. Other findings included a perivascular lymphocytic infiltrate (n=5), features of active inflammation (n=4), and metallosis (n=1). CONCLUSION:A significant number of patients with metal-on-metal hip replacements presented with early postoperative pain because of an abnormal soft-tissue reaction. MRI can demonstrate characteristic soft-tissue disease in these patients where conventional radiographs are frequently normal.
journal_name
Clin Radioljournal_title
Clinical radiologyauthors
Toms AP,Marshall TJ,Cahir J,Darrah C,Nolan J,Donell ST,Barker T,Tucker JKdoi
10.1016/j.crad.2007.07.012subject
Has Abstractpub_date
2008-01-01 00:00:00pages
49-58issue
1eissn
0009-9260issn
1365-229Xpii
S0009-9260(07)00315-7journal_volume
63pub_type
杂志文章abstract::Ultrasonic imaging of the pancreas is often impaired by overlying bowel gas. Oxygen therapy has, in the past, been shown to be effective in reducing the gas in the cysts of pneumatosis coli. Using the same hypothesis, a randomized, single blind study comparing ultrasonic imaging of the pancreas with and without prior ...
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pub_type: 临床试验,杂志文章,随机对照试验
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