Total hip arthroplasty (THA) has been successful in achieving pain reduction, but recent concerns have been raised regarding the development of adverse local tissue reactions (ALTRs). Our previous application focused on utilizing MRI as a noninvasive biomarker of ALTR, so that appropriate intervention can be recommended before extensive damage occurs. By evaluating THAs of different bearing materials we found: 1) MRI can detect and distinguish wear debris from THA; 2) MRI is sensitive to ALTR damage from different articulating surfaces; and 3) variable host-mediated response to wear debris mounts distinct morphologic patterns on MRI. There is continued interest in the evaluation of soft tissues near THAs as traditional THA designs, including metal-on-polyethylene (MOP) and ceramic-on-polyethylene (COP) bearing surfaces, have recently been implicated in ALTRs. It is believed that fretting and corrosion at the head-neck junction is responsible for ALTRs, secondary to flexural rigidity and other implant mechanical features. If a greater prevalence of ALTR is found in components with more flexible connections, this could drive the practice of THA to stiffer connections. In this renewal application, we will evaluate two important causes of implant failure: (1) in designs not traditionally associated with ALTRs such as metal-on-polyethylene (MOP) and ceramic-on-polyethylene (COP) we will assess patients indicated for revision THA surgery with MRI and correlate the imaging metrics to targeted biopsy retrieval obtained at the time of revision (including the trunnion), the extent of tissue damage documented at surgery, and implant retrieval analysis of the neck trunnion, including flexural rigidity analysis; and (2) to longitudinally assess implant integration using qualitative MRI evaluation of the bone-implant interface as well as quantitative MRI techniques, T2 mapping and T2* mapping using MAVRIC-UTE, to evaluate relaxometry at the interface.

Public Health Relevance

Patients with a total hip replacement may require early revision surgery due to an adverse local tissue reaction or bone resorption that occurs due to wear debris released from the implant. MRI provides a non-invasive biomarker for clinicians and surgeons to detect early adverse synovial reactions which may exist in the absence of clinical symptoms, thus imparting essential information for clinical management. This proposal will address two of the most commons causes of hip implant failure, including adverse local tissue reaction in implants not traditionally associated with adverse tissue reactions, as well as the presence of aseptic loosening and loss of implant-bone integration.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR064840-06
Application #
9565951
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Washabaugh, Charles H
Project Start
2013-08-15
Project End
2023-07-31
Budget Start
2019-08-01
Budget End
2020-07-31
Support Year
6
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Hospital for Special Surgery
Department
Type
DUNS #
City
New York
State
NY
Country
United States
Zip Code
10021
Koch, Kevin M; Koff, Matthew F; Bauer, Thomas W et al. (2018) Off-resonance based assessment of metallic wear debris near total hip arthroplasty. Magn Reson Med 79:1628-1637
Berkowitz, Jennifer L; Potter, Hollis G (2017) Advanced MRI Techniques for the Hip Joint: Focus on the Postoperative Hip. AJR Am J Roentgenol 209:534-543
Koff, Matthew F; Burge, Alissa J; Koch, Kevin M et al. (2017) Imaging near orthopedic hardware. J Magn Reson Imaging 46:24-39
Fritz, Jan; Lurie, Brett; Potter, Hollis G (2015) MR Imaging of Knee Arthroplasty Implants. Radiographics 35:1483-501