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HSS J. 2018 Oct;14(3):286-293. doi: 10.1007/s11420-018-9629-1. Epub 2018 Aug 23.

MRI Findings at the Bone-Component Interface in Symptomatic Unicompartmental Knee Arthroplasty and the Relationship to Radiographic Findings.

Author information

1
1Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021 USA.
2
2Department of Orthopaedic Surgery, Academic Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
3
3Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.

Abstract

Background:

The most common modes of failure of cemented unicompartmental knee arthroplasty (UKA) designs are aseptic loosening and unexplained pain at short- to mid-term follow-up, which is likely linked to early fixation failure. Determining these modes of failure remains challenging; conventional radiographs are limited for use in assessing radiolucent lines, with only fair sensitivity and specificity for aseptic loosening.

Questions/Purposes:

We sought to characterize the bone-component interface of patients with symptomatic cemented medial unicompartmental knee arthroplasty (UKA) using magnetic resonance imaging (MRI) and to determine the relationship between MRI and conventional radiographic findings.

Methods:

This retrospective observational study included 55 consecutive patients with symptomatic cemented UKA. All underwent MRI with addition of multiacquisition variable-resonance image combination (MAVRIC) at an average of 17.8 ± 13.9 months after surgery. MRI studies were reviewed by two independent musculoskeletal radiologists. MRI findings at the bone-cement interface were quantified, including bone marrow edema, fibrous membrane, osteolysis, and loosening. Radiographs were reviewed for existence of radiolucent lines. Inter-rater agreement was determined using Cohen's κ statistic.

Results:

The vast majority of symptomatic UKA patients demonstrated bone marrow edema pattern (71% and 75%, respectively) and fibrous membrane (69% and 89%, respectively) at the femoral and tibial interface. Excellent and substantial inter-rater agreement was found for the femoral and tibial interface, respectively. Furthermore, MRI findings and radiolucent lines observed on conventional radiographs were poorly correlated.

Conclusion:

MRI with the addition of MAVRIC sequences could be a complementary tool for assessing symptomatic UKA and for quantifying appearances at the bone-component interface. This technique showed good reproducibility of analysis of the bone-component interface after cemented UKA. Future studies are necessary to define the bone-component interface of symptomatic and asymptomatic UKA patients.

KEYWORDS:

MRI; bone-component interface; implant integration; multiacquisition variable-resonance image combination (MAVRIC); unicompartmental knee arthroplasty

Conflict of interest statement

Laura J. Kleeblad, MD, Hendrik A. Zuiderbaan, MD, PhD, Alissa J. Burge, MD, Mark J. Amirtharaj, BS, declare that they have no conflicts of interest. Hollis G. Potter, MD, reports receiving grants from GE Healthcare, during the conduct of the study. Andrew D. Pearle, MD, reports receiving personal fees from Stryker Corporation and Exactech and personal fees from Zimmer Biomet, outside the submitted work.All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.Informed consent was waived from all patients for being included in this study.Disclosure forms provided by the authors are available with the online version of this article.

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