MR Imaging of Adverse Local Tissue Reactions around Rejuvenate Modular Dual-Taper Stems
Alissa J Burge1, Stephanie L Gold1, Brett Lurie1
1From the Department of Radiology and Imaging, MRI Division (A.J.B., S.L.G., B.L., D.H.N., K.G.F.), Department of Orthopedic Surgery (G.W.), and Department of Radiology and Imaging (H.G.P.), Hospital for Special Surgery, 535 E 70th St, New York NY 10021; and Department of Radiology, Weill Cornell Medical College of Cornell University, New York, NY (M.F.K.).
Purpose:
To describe the magnetic resonance (MR) imaging characteristics associated with adverse local tissue reactions and tissue damage around hip arthroplasties in which the recalled Rejuvenate modular dual-taper stem was used.
Materials And Methods:
The institutional review board of the Hospital for Special Surgery approved the study. All study patients provided informed consent. MR imaging studies were retrospectively reviewed in a cohort of 58 patients with 66 hip arthroplasties with Rejuvenate stems who had presented for imaging evaluation because of recall of the implant. Multiple regression analysis was used to examine MR imaging features, biomechanical factors, and metal ion levels as predictors of aseptic lymphocytic vasculitis-associated lesion (ALVAL) score at histologic assessment while adjusting for age and sex for 54 revised hips.
Results:
Revision surgery was performed in 54 hips on the basis of clinical or imaging findings (24% of hips were completely asymptomatic). The median ALVAL score among the revised hips was 9 (range, 1-10). Imaging characteristics observed with high frequency in patients with ALVAL included synovitis, mixed- or solid-type synovitis, synovial thickening, and capsular dehiscence.
Conclusion:
MR imaging provides an effective noninvasive method for assessing the presence and severity of adverse local tissue reaction, as well as the degree of pre-existing tissue damage, thereby facilitating early and accurate identification of candidates for revision surgery.
Insights
Magnetic resonance (MR) imaging effectively identifies adverse tissue reactions around recalled Rejuvenate hip implants. This aids in early detection of tissue damage and guides revision surgery decisions.
Area of Science:
- Orthopedic Surgery
- Radiology
- Biomaterials Science
Background:
- The Rejuvenate modular dual-taper stem hip arthroplasty was recalled due to concerns about adverse local tissue reactions.
- Assessing tissue damage around these implants noninvasively is crucial for patient management.
Purpose of the Study:
- To characterize magnetic resonance (MR) imaging findings associated with adverse local tissue reactions and damage surrounding hip arthroplasties utilizing the recalled Rejuvenate stem.
Main Methods:
- Retrospective review of MR imaging studies in 58 patients (66 hips) with Rejuvenate stems presenting after implant recall.
- Analysis correlated MR imaging features, biomechanical factors, and metal ion levels with histologic aseptic lymphocytic vasculitis-associated lesion (ALVAL) scores.
Main Results:
- Revision surgery was performed in 54 hips, with 24% being asymptomatic.
- The median ALVAL score in revised hips was 9.
- Common MR imaging findings included synovitis (mixed or solid type), synovial thickening, and capsular dehiscence.
Conclusions:
- MR imaging is an effective noninvasive tool for evaluating the severity of adverse local tissue reactions and pre-existing tissue damage.
- This facilitates early and accurate identification of patients requiring revision surgery for Rejuvenate hip arthroplasties.
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