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Magnetic Resonance Imaging Findings in Symptomatic Versus Asymptomatic Subjects Following Metal-on-Metal Hip Resurfacing Arthroplasty
Danyal H. Nawabi, MD, FRCS(Orth)1; Catherine L. Hayter, MBBS, FRANZCR1; Edwin P. Su, MD1; Matthew F. Koff, PhD1; Giorgio Perino, MD1; Stephanie L. Gold, BA1; Kevin M. Koch, PhD2; Hollis G. Potter, MD1
1 Adult Reconstruction and Joint Replacement Division (D.H.N.), Department of Radiology and Imaging (C.L.H., M.F.K., S.L.G., and H.G.P.), Center for Hip Pain and Preservation (E.P.S.), and Department of Pathology and Laboratory Medicine (G.P.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for H.G. Potter: potterh@hss.edu
2 Applied Science Laboratory, General Electric Healthcare, 3200 North Grandview Boulevard, Waukesha, WI 53188
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Investigation performed at the Hospital for Special Surgery, New York, NY

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 May 15;95(10):895-902. doi: 10.2106/JBJS.K.01476
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Although pseudotumors have been reported at the sites of well-functioning and painful metal-on-metal hip prostheses, there are no objective data on the magnitude of the adverse reaction. This observational study was performed to investigate the ability of modified magnetic resonance imaging (MRI) to detect and quantify adverse synovial responses in symptomatic and asymptomatic subjects following metal-on-metal hip resurfacing. We hypothesized that the magnitude of the synovial reactions would be greater in symptomatic patients.


Sixty-nine patients (seventy-four hips) with hip resurfacing were divided into three groups: asymptomatic (twenty-two hips), symptomatic with a mechanical cause (twenty), and unexplained pain (thirty-two). The volume of synovitis was calculated on MRI for all patients.


Synovitis was detected in fifteen asymptomatic hips (68%), fifteen (75%) with symptoms with a mechanical causes, and twenty-five (78%) with unexplained pain. The mean volume (and standard deviation) of the synovitis in these groups was 5 ± 7 cm3, 10 ± 16 cm3, and 31 ± 47 cm3, respectively. The coefficient of repeatability between the examiners was 1.8 cm3 for measurement of synovitis. Of the thirteen subjects with revision arthroplasty, six had an adverse local tissue reaction. This subgroup had the highest volumes of synovitis on MRI.


An adverse synovial reaction was detected on MRI in both symptomatic and asymptomatic subjects. We found a larger volume of synovitis in symptomatic patients; this increase reached significance only in the group with an adverse local tissue reaction. Synovial volume on MRI may be a valuable marker in the longitudinal assessment of asymptomatic patients with a metal-on-metal hip resurfacing and in identifying patients with adverse local tissue reaction.

Level of Evidence: 

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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