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MR imaging after hip and knee replacement
Sebastian Koch1, Alejandro Forteza, Carlos Lavernia
1Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA. skoch@med.miami.edu
Background:
Diffusion-weighted (DW) imaging abnormalities often develop in patients after invasive procedures associated with cerebral microembolism. Cerebral microembolism has recently been shown during orthopedic surgery. We here examine the effects of intraoperative microembolism on acute magnetic resonance(MR) imaging in patients undergoing hip and knee replacement.
Methods:
We enrolled 24 patients, at least 65 years old, requiring elective knee or hip replacement surgery. MR with DW and axial fluid-attenuated inversion recovery (FLAIR) imaging was performed pre- and postoperatively. All patients were monitored intraoperatively for microemboli.
Results:
The mean age of patients was 74 years. All patients had intraoperative microemboli. The mean number of emboli detected was 9.9 +/- 18 per surgery. MR imaging was obtained a mean of 3.5 days postoperatively. No DW imaging abnormalities were found after surgery. One patient had new findings on postoperative FLAIR imaging.
Conclusion:
Intraoperative microembolism occurred universally, but did not lead to acute DW imaging abnormalities following knee and hip replacement. Acute imaging abnormalities on FLAIR imaging are rare but may occasionally occur after joint surgery.
Insights
Intraoperative microembolism is common during hip and knee replacement surgery. However, diffusion-weighted (DW) imaging shows no acute abnormalities after these procedures, indicating safety.
Area of Science:
- Neurology
- Radiology
- Orthopedic Surgery
Background:
- Invasive procedures, including orthopedic surgery, can cause cerebral microembolism.
- Diffusion-weighted (DW) imaging abnormalities are often seen after procedures linked to cerebral microembolism.
Purpose of the Study:
- To investigate the impact of intraoperative microembolism on acute magnetic resonance (MR) imaging in patients undergoing hip and knee replacement.
Main Methods:
- 24 patients aged 65+ undergoing elective hip or knee replacement were enrolled.
- Pre- and postoperative MR imaging, including DW and FLAIR sequences, was performed.
- Intraoperative monitoring for microemboli was conducted.
Main Results:
- All patients experienced intraoperative microemboli (mean 9.9 +/- 18 per surgery).
- Postoperative MR imaging, obtained a mean of 3.5 days later, revealed no DW imaging abnormalities.
- One patient showed new findings on postoperative FLAIR imaging.
Conclusions:
- Universal intraoperative microembolism occurred in hip and knee replacement patients.
- No acute DW imaging abnormalities were detected post-surgery.
- FLAIR imaging abnormalities are rare but possible after joint replacement surgery.
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