Frondlike Synovitis on MRI and Correlation With Polyethylene Surface Damage of Total Knee Arthroplasty

The purpose of this study is to determine the association between polyethylene surface damage and the severity of frondlike hypertrophied synovitis, joint distention, capsular thickness, and osteolysis on MRI compared with other patient factors. Another goal of this study is to ascertain the interobserver reliability in MRI evaluation of synovitis.

MR images of 61 patients who had undergone revision total knee arthroplasty (TKA) were retrospectively reviewed. The two MRI reviewers were blinded to clinical and retrieval data. The retrieved polyethylene tibial inserts were graded to determine the severity of surface damage. The association of MRI features with surface damage was assessed using Spearman correlation coefficients and multiple linear regression. Interobserver reliability was assessed using the kappa statistic.

Correlations were moderate between the surface damage score and MRI synovitis severity (r = 0.46; p < 0.001) and joint distention (r = 0.41; p = 0.001). Multiple linear regression showed that the MRI synovitis score (p = 0.045), male sex (p = 0.007), body mass index (p = 0.041), and the time since implantation (p < 0.0001) predicted the surface damage score. Substantial interobserver agreement was shown for MRI grading of synovitis (κ = 0.72; 95% CI, 0.65-0.80).

The magnitude of frondlike hypertrophied synovitis on MRI is significantly associated with polyethylene surface damage in patients who undergo revision TKA. The finding of severe frondlike synovitis on MR images of patients with TKA should raise the possibility of polyethylene surface damage. However, time since implantation is a stronger predictor of surface damage.