Abstract：
BACKGROUND:Adverse local tissue reactions (ALTR) around metal-on-metal (MOM) hip arthroplasties are increasingly being recognized as a cause of failure. These reactions may be associated with intraoperative tissue damage and complication rates as high as 50% after revision. Although MRI can identify ALTR in MOM hips, it is unclear whether the MRI findings predict those at revision surgery. QUESTIONS/PURPOSES:We therefore (1) identified which MRI characteristics correlated with histologically confirmed ALTR (using the aseptic lymphocytic vasculitis-associated lesions [ALVAL] score) and intraoperative tissue damage and (2) developed a predictive model using modified MRI to detect ALVAL and quantify intraoperative tissue damage. METHODS:We retrospectively reviewed 68 patients with failed MOM hip arthroplasties who underwent preoperative MRI and subsequent revision surgery. Images were analyzed to determine synovial volume, osteolysis, and synovial thickness. The ALVAL score was used to grade tissue samples, thus identifying a subset of patients with ALTR. Intraoperative tissue damage was graded using a four-point scale. Random forest analysis determined the sensitivity and specificity of MRI characteristics in detecting ALVAL (score ≥ 5) and intraoperative tissue damage. RESULTS:Maximal synovial thicknesses and synovial volumes as determined on MRI correlated with the ALVAL score and were higher in cases of severe intraoperative tissue damage. Our MRI predictive model showed sensitivity and specificity of 94% and 87%, respectively, for detecting ALVAL and 90% and 86%, respectively, for quantifying intraoperative tissue damage. CONCLUSIONS:MRI is sensitive and specific in detecting ALVAL and tissue damage in patients with MOM hip implants. MRI can be used as a screening tool to guide surgeons toward timely revision surgery.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Nawabi DH,Gold S,Lyman S,Fields K,Padgett DE,Potter HGdoi
10.1007/s11999-013-2788-ysubject
Has Abstractpub_date
2014-02-01 00:00:00pages
471-81issue
2eissn
0009-921Xissn
1528-1132journal_volume
472pub_type
杂志文章abstract：UNLABELLED:New prostheses should be evaluated for stability and clinical performance. In a prospective randomized clinical trial, we implanted 22 titanium (Ti) and 20 hydroxyapatite-coated (HA) ProxiLock femoral hip prostheses during total hip arthroplasty in 42 patients. The patients were followed for 24 months with c...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,随机对照试验
doi：10.1097/01.blo.0000224011.12175.83
更新日期：2006-07-01 00:00:00
abstract：:One hundred and five patients were treated by instrumentation for various spinal conditions by means of the posterior route. There were 90 patients with scoliosis in this series. Of these, 61 cases (67.7%) were corrected by Harrington distraction rod and segmental wire fixation. The various degrees of deformity in the...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1987-02-01 00:00:00
abstract：:There is no standardized method reported in the literature to measure ROM of the ankle after a total ankle arthroplasty, which limits the possibility to compare results from the various ankle designs. It seems that most of the measurements are a combination of ankle and midfoot motion, not the tibiotalar joint. A prot...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000132180.69464.84
更新日期：2004-07-01 00:00:00
abstract：:Fifty-two Stanmore hinged knee replacements were used as revision arthroplasties for failed arthroplasties. The patients were followed for a mean of 44.7 months. On clinical examination, 23% had good, 48% fair, and 29% poor results. Worst results were achieved when revising bulkier or more constrained primary knee joi...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1987-07-01 00:00:00
abstract：:Semitendinosus anatomic reconstruction (STAR) rebuilds the major anatomic bands of the anterior cruciate ligament (ACL) and provides isometric ligamentous relationships. STAR secures a graft firmly enough to allow intraoperative testing and early motion. It provides a graft comparable in strength with a normal ACL and...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1983-01-01 00:00:00
abstract：:Periosteal osteosarcoma is a surface lesion without evidence of medullary involvement. This report extends the Mayo Clinic series of periosteal osteosarcoma cases from 11 to 22 cases. In a review of demographic information from our 22 cases and from 30 additional cases, referred only for pathologic diagnosis, the aver...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1987-06-01 00:00:00
abstract：:Recurrent dislocation of the elbow with paradoxical dislocation of the ulnar nerve complicated by neuropathy may occur from avulsion of the lateral epicondyle and laxity of the collateral ligaments. In a 22-year-old man, the injury was successfully treated by plication of the collateral ligaments. The nerve dislocatio...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1981-11-01 00:00:00
abstract：:To evaluate the effects of nonweight bearing on joints (weight-free range, five to 92 months), bilateral hips of 20 patients with amputated lower limbs or nonunion of the femur were studied clinically and roentgenographically. The nonweight-bearing side showed a roentgenographic narrowing of the joint space of 10% or ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1992-06-01 00:00:00
abstract：:The Jehovah's Witnesses do not accept allogeneic blood transfusion or certain types of autologous blood transfusion and, therefore, present the orthopaedic surgeon with a challenge in the management of perioperative blood loss. Accepting a patient who is a Jehovah's Witness as a surgical candidate requires the surgeon...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-199912000-00026
更新日期：1999-12-01 00:00:00
abstract：:Osteonecrosis (aseptic or avascular necrosis of bone) is an entity with many causes that can occur at a variety of sites. It is a known complication of corticosteroid therapy, either alone or combined with other drugs in the treatment of malignancy. Osteonecrosis associated with chemotherapy that does not include cort...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1986-03-01 00:00:00
abstract：BACKGROUND:There are few data on the types of procedures orthopaedic oncologists perform in their first years of practice. Because fellowships are graduating fellows each year and the number of tumor patients is limited, defining the practice patterns of early-career orthopaedic oncologists may help diminish early empl...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-014-3934-x
更新日期：2015-02-01 00:00:00
abstract：:The commonly used classification systems of hip dislocation are based on the direction of the dislocation and the presence of associated lesions. However, no rating system can reliably predict the patient's outcome and prognosis based on the initial presentation and classification. In general, patients with anterior d...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200008000-00004
更新日期：2000-08-01 00:00:00
abstract：:Despite the implication that mechanical overload is fundamental to the development of plantar fasciitis, gait analysis has revealed inconsistent findings regarding its effect on lower limb loading. The aim of the current study was to evaluate the regional vertical ground reaction force in patients with and without pla...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000057989.41099.d8
更新日期：2003-04-01 00:00:00
abstract：:From July 1988 to June 1991, 110 complex acetabular fractures were operatively treated. A triradiate approach was used in 38 patients and an extended iliofemoral approach in 21. The mean patient age was 32 years (range, 15-80 years). These 59 patients were followed for a minimum of 36 months postoperatively. The posto...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1994-08-01 00:00:00
abstract：:Although the Chiari osteotomy is usually effective in reducing pain, many patients are left with a long-term limp. The postoperative limp can at times be caused by hip abductors that have strength insufficient to counteract the torque from body weight during single-leg stance. To study how the surgical technique affec...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1990-05-01 00:00:00
abstract：BACKGROUND:Persistent inflammatory reaction to wear debris causes periprosthetic osteolysis and loosening. Some authors have advocated pharmaceutical approaches to reduce the inflammatory reaction. Erythromycin has antiinflammatory effects independent of its antimicrobial properties. Although oral erythromycin reported...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-011-1918-7
更新日期：2011-08-01 00:00:00
abstract：:Chronic extensor mechanism ruptures are uncommon but challenging clinical problems. Previously published procedures for treating chronic extensor mechanism ruptures assume an intact patella is available to anchor the repair. A case is presented of a patient who had a previous patellectomy, followed by rupture of the e...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-199812000-00018
更新日期：1998-12-01 00:00:00
abstract：:Previously, a major limitation to percutaneous disc decompression to relieve symptoms of sciatica was the inability to approach the L5-S1 level. Obstruction by the iliac crest prevented the instrumentation from entering the L5-S1 disc space. In this paper, the authors describe a curved cannula which can be placed down...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1989-01-01 00:00:00
abstract：UNLABELLED:We review evidence-based treatments for patients seeking care for lower-back pain and patients who have been diagnosed with nonspecific lower-back pain. The review is based on selected systematic reviews and national and international guidelines for the treatment of lower-back pain. Additional randomized con...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/01.blo.0000198721.75976.d9
更新日期：2006-02-01 00:00:00
abstract：:Forty-six hands of 23 cadavers (15 female and 8 male) were dissected to observe the patterns of distribution of the median nerve. The findings showed that in 33 hands the median nerve had a normal distribution of its branches. Also identified was the commonly recognized transligamentous variant, where the recurrent br...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1998-07-01 00:00:00
abstract：:Surgical procedures are performed on the nonfunctional upper extremity following stroke to correct spastic flexion contractures that cause pain or prevent adequate hygiene. In the upper extremity surgical procedures are most commonly performed to improve extension at the wrist, fingers or thumb. If the deformity is pr...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1978-03-01 00:00:00
abstract：:The magnetic resonance (MR) signal behavior of freshly excised pig femoral heads undergoing ischemic necrosis in vitro was evaluated. Ten femoral heads removed from skeletally immature pigs were stored at 37 degrees in a sealed, sterile container during the observation period. Imaging was initially performed 40 minute...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1989-07-01 00:00:00
abstract：:Ninety-one cases of histologically confirmed osteoid osteoma were collected during an 11-year period; of them, seven (7.6%) had onset of symptoms while younger than five years of age. Special diagnostic difficulties were found in this specific age group: most cases were misdiagnosed or diagnosed incorrectly. The time ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1993-11-01 00:00:00
abstract：:This is a report of outcomes after a review of the demographic, diagnostic, therapeutic, and survival data for patients with pelvic primary and secondary tumors treated during the past 28 years. Using a computerized system it has been possible to assess the results for 206 patients with bone and soft tissue sarcomas a...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200408000-00030
更新日期：2004-08-01 00:00:00
abstract：:Primary total hip arthroplasties were performed in 108 patients (116 hips) using a porous coated anatomic (PCA) hip system. Nineteen (22 hips) of 108 patients (116 hips) who had a subsidence of a PCA femoral stem more than 3 mm were studied for the time onset, the amount of stem subsidence, and outcomes. A minimum fol...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1993-10-01 00:00:00
abstract：:Twenty of 21 consecutive patients (21 heels) with subcalcaneal pain retractory to conservative treatment managed by resection of the proximal attachment of the plantar fascia and the heel spur, if present, were reviewed retrospectively. The results, at a mean followup of 40 months (range, 12-102 months), using a 100 p...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-199611000-00023
更新日期：1996-11-01 00:00:00
abstract：:Thirty-two total hip arthroplasties (THAs) were performed on 26 severely incapacitated patients with congenital dislocation of the hip. The arthroplasty technique varied with the problems encountered, but the cup was always placed in the true acetabulum. In 19 cases, femoral head autografts were transplanted. The over...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1989-05-01 00:00:00
abstract：:Two current areas of research on hard tissues have focused upon acidic lipids associated with the local mechanism of calcification and the presence of matrix vesicles as the loci for initial mineralization. Data which show that acidic phospholipids are a component of the vesicle membrane provide a common denominator b...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1976-07-01 00:00:00
abstract：:Postoperative infection of elective surgical wounds with Clostridium species has been linked to gastrointestinal tract lesions. A 55-year-old man with a history of peptic ulcer disease was treated by open reduction and internal fixation with autogeneic cancellous bone grafting from an anterior iliac crest donor site f...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1993-08-01 00:00:00
abstract：:To determine the clinical efficacy of an alumina ceramic head, 119 cemented total hip arthroplasties in 97 patients using an alumina head coupled with ethylene oxide gas sterilized polyethylene were reviewed. Eighty-two patients (101 hips) with greater than 10 years followup were evaluated clinically and radiographica...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200110000-00022
更新日期：2001-10-01 00:00:00
