MRI as Diagnostic Modality for Analyzing the Problematic Knee Arthroplasty: A Systematic Review

Area of Science:

• Orthopedic surgery
• Radiology
• Medical imaging

Background:

• Assessing problematic knee arthroplasty often involves various diagnostic methods.
• Visualizing soft-tissue structures around knee implants and bone is challenging.
• Advancements in MRI sequences offer potential for improved diagnostic capabilities.

Purpose of the Study:

• To review the diagnostic performance of MRI for knee arthroplasty.
• To identify MRI's ability to detect implant failure causes like infection, loosening, wear, instability, malalignment, arthrofibrosis, and patellofemoral issues.

Main Methods:

• Systematic review of 23 studies (16 total knee arthroplasty, 4 unicompartmental knee arthroplasty, 3 cadaveric).
• Searched PubMed, SCOPUS, and EMBASE databases.
• Assessed risk of bias using COSMIN and QUADAS-2 criteria.

Main Results:

• Fifteen studies evaluated reproducibility for infection, loosening, wear, and malalignment, with adequate to good quality.
• Moderate to excellent agreement (ICC/K 0.55-0.97) was found for reproducibility.
• Sensitivity and specificity for infection and loosening/wear ranged from 0.85-0.97 and 0.70-1.00.
• Excellent accuracy (r≥0.81) was observed for malalignment diagnosis.
• QUADAS-2 analysis indicated few risks of bias in relevant studies.

Conclusions:

• MRI demonstrates reproducible and accurate results for diagnosing infection, loosening, wear, and malalignment post-knee arthroplasty.
• Limited and inconclusive evidence exists for MRI in diagnosing instability, arthrofibrosis, or patellofemoral problems.
• Further research is needed for these specific indications.