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MRI Characteristics of Adverse Local Tissue Reactions Associated With Intraoperative Tissue Damage and Poor Revision

Liang Xiong1, Evan J Smith, Christian Klemt

  • 1Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

The Journal of the American Academy of Orthopaedic Surgeons
|November 17, 2020
PubMed
Abstract

Insights

Metal artifact reduction sequence (MARS) MRI findings, including synovial composition and abductor disruption, predict tissue necrosis and complications in hip replacement revisions. These MARS MRI characteristics aid surgical planning and patient counseling.

Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Biomedical Engineering

Background:

  • Metal artifact reduction sequence (MARS) MRI is used for diagnosing adverse local tissue reaction (ALTR).
  • Revision total hip arthroplasty (THA) is often necessitated by ALTR.
  • Evaluating MARS MRI characteristics linked to intraoperative necrosis and postoperative complications in revision THA is crucial.

Purpose of the Study:

  • To review literature on MARS MRI findings in failed THA with ALTR.
  • To correlate MRI characteristics with intraoperative tissue necrosis.
  • To assess the relationship between MRI findings and postoperative complications.

Main Methods:

  • Systematic literature search for studies reporting MARS MRI in ALTR.
  • Inclusion of studies correlating MRI findings with intraoperative and postoperative outcomes.
  • Assessment of 617 studies, with 15 meeting inclusion criteria.

Main Results:

  • Synovial wall thickness showed a weak correlation with tissue necrosis.
  • Mixed or solid synovial composition and abductor disruption correlated with complications and necrosis.
  • Tissue edema was an unreliable predictor of ALVAL grade or necrosis.

Conclusions:

  • MARS MRI features like synovial composition (mixed/solid) and abductor disruption are key predictors.
  • These findings correlate with intraoperative soft-tissue necrosis and revision surgery outcomes.
  • MARS MRI characteristics can improve surgical intervention criteria and preoperative counseling.

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