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Low-Field-Strength MR Imaging of Failed Hip Arthroplasty: Association of Femoral Periprosthetic Signal Intensity with Radiographic, Surgical, and Pathologic Findings¹

¹ From the Department of Radiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (H.S., A.F., Y.K., W.Y.); Department of Orthopedics, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Kanagawa, Japan (I.H., Y.I.); and Department of Science, Tokyo University of Science, Japan (E.M.). Received August 29, 2002; revision requested October 24; final revision received April 25, 2003; accepted May 19. Address correspondence to H.S., Department of Radiology, Jichi Medical School, 3311 Yakushiji, Minamikawachimachi, Kawachi-gun, Tochigi-ken 329-0431, Japan (e-mail: sugimoto@jichi.ac.jp).

View larger version (23K): [in a new window]   Figure 1. Diagram shows division of the hip prosthesis into the seven Gruen segments (14).

View larger version (70K): [in a new window]   Figure 2a. (a) Anteroposterior radiograph of the right hip in a 70-year-old woman who subsequently underwent revision surgery. A cemented femoral prosthesis and breakage of the acetabular component (arrow) are seen. Nonfocal lucency (arrowheads) at the cement-bone interface is seen in zones 5-7. (b) Fast STIR oblique coronal (3,000/40/100) MR image shows signal intensity in zones 1-4 (arrowhead) and 7 equal to that of bone marrow and increased signal intensity in zones 5 and 6 (arrow). (c) T1-weighted SE (340/15) oblique coronal MR image obtained after injection of contrast material. The cement-bone interface shows no contrast enhancement; therefore, zones 5 and 6 show type I signal intensity (arrow), and the remaining zones show type III signal intensity (arrowhead).

View larger version (96K): [in a new window]   Figure 2b. (a) Anteroposterior radiograph of the right hip in a 70-year-old woman who subsequently underwent revision surgery. A cemented femoral prosthesis and breakage of the acetabular component (arrow) are seen. Nonfocal lucency (arrowheads) at the cement-bone interface is seen in zones 5-7. (b) Fast STIR oblique coronal (3,000/40/100) MR image shows signal intensity in zones 1-4 (arrowhead) and 7 equal to that of bone marrow and increased signal intensity in zones 5 and 6 (arrow). (c) T1-weighted SE (340/15) oblique coronal MR image obtained after injection of contrast material. The cement-bone interface shows no contrast enhancement; therefore, zones 5 and 6 show type I signal intensity (arrow), and the remaining zones show type III signal intensity (arrowhead).

View larger version (85K): [in a new window]   Figure 2c. (a) Anteroposterior radiograph of the right hip in a 70-year-old woman who subsequently underwent revision surgery. A cemented femoral prosthesis and breakage of the acetabular component (arrow) are seen. Nonfocal lucency (arrowheads) at the cement-bone interface is seen in zones 5-7. (b) Fast STIR oblique coronal (3,000/40/100) MR image shows signal intensity in zones 1-4 (arrowhead) and 7 equal to that of bone marrow and increased signal intensity in zones 5 and 6 (arrow). (c) T1-weighted SE (340/15) oblique coronal MR image obtained after injection of contrast material. The cement-bone interface shows no contrast enhancement; therefore, zones 5 and 6 show type I signal intensity (arrow), and the remaining zones show type III signal intensity (arrowhead).

View larger version (70K): [in a new window]   Figure 3a. (a) Anteroposterior radiograph of the left hip in a 67-year-old woman who subsequently underwent revision surgery for loosening of a femoral component. A cementless femoral prosthesis and wire around the trochanteric region are seen. Nonfocal lucency (arrows) is seen in zones 1-3 and 5-7. (b) Fast STIR oblique coronal (3,000/40/100) MR image shows higher signal intensity in zones 1-3 and 5-7 than in the bone marrow of the distal femur (arrows). Metallic artifact due to a stainless steel tip deteriorated MR signal intensity in zone 4. (c) T1-weighted SE (340/15) oblique coronal MR image obtained after injection of contrast material. Linear enhancement (arrows) is seen along the femoral prosthesis. Hence, zones 1-3 and 5-7 show type II signal intensity. At surgery, the stem was found to be unstable. (d) Photomicrograph from all zones shows fibrotic tissue with pseudosynovium lining cells (arrowheads). (Hematoxylin-eosin stain; original magnification, x50.)

View larger version (100K): [in a new window]   Figure 3b. (a) Anteroposterior radiograph of the left hip in a 67-year-old woman who subsequently underwent revision surgery for loosening of a femoral component. A cementless femoral prosthesis and wire around the trochanteric region are seen. Nonfocal lucency (arrows) is seen in zones 1-3 and 5-7. (b) Fast STIR oblique coronal (3,000/40/100) MR image shows higher signal intensity in zones 1-3 and 5-7 than in the bone marrow of the distal femur (arrows). Metallic artifact due to a stainless steel tip deteriorated MR signal intensity in zone 4. (c) T1-weighted SE (340/15) oblique coronal MR image obtained after injection of contrast material. Linear enhancement (arrows) is seen along the femoral prosthesis. Hence, zones 1-3 and 5-7 show type II signal intensity. At surgery, the stem was found to be unstable. (d) Photomicrograph from all zones shows fibrotic tissue with pseudosynovium lining cells (arrowheads). (Hematoxylin-eosin stain; original magnification, x50.)

View larger version (103K): [in a new window]   Figure 3c. (a) Anteroposterior radiograph of the left hip in a 67-year-old woman who subsequently underwent revision surgery for loosening of a femoral component. A cementless femoral prosthesis and wire around the trochanteric region are seen. Nonfocal lucency (arrows) is seen in zones 1-3 and 5-7. (b) Fast STIR oblique coronal (3,000/40/100) MR image shows higher signal intensity in zones 1-3 and 5-7 than in the bone marrow of the distal femur (arrows). Metallic artifact due to a stainless steel tip deteriorated MR signal intensity in zone 4. (c) T1-weighted SE (340/15) oblique coronal MR image obtained after injection of contrast material. Linear enhancement (arrows) is seen along the femoral prosthesis. Hence, zones 1-3 and 5-7 show type II signal intensity. At surgery, the stem was found to be unstable. (d) Photomicrograph from all zones shows fibrotic tissue with pseudosynovium lining cells (arrowheads). (Hematoxylin-eosin stain; original magnification, x50.)

View larger version (116K): [in a new window]   Figure 3d. (a) Anteroposterior radiograph of the left hip in a 67-year-old woman who subsequently underwent revision surgery for loosening of a femoral component. A cementless femoral prosthesis and wire around the trochanteric region are seen. Nonfocal lucency (arrows) is seen in zones 1-3 and 5-7. (b) Fast STIR oblique coronal (3,000/40/100) MR image shows higher signal intensity in zones 1-3 and 5-7 than in the bone marrow of the distal femur (arrows). Metallic artifact due to a stainless steel tip deteriorated MR signal intensity in zone 4. (c) T1-weighted SE (340/15) oblique coronal MR image obtained after injection of contrast material. Linear enhancement (arrows) is seen along the femoral prosthesis. Hence, zones 1-3 and 5-7 show type II signal intensity. At surgery, the stem was found to be unstable. (d) Photomicrograph from all zones shows fibrotic tissue with pseudosynovium lining cells (arrowheads). (Hematoxylin-eosin stain; original magnification, x50.)

View larger version (75K): [in a new window]   Figure 4a. (a) Anteroposterior radiograph of the right hip in a 64-year-old woman who subsequently underwent revision surgery for osteolysis (arrows) of the acetabulum. A cementless bipolar femoral prosthesis is seen. No sclerosis or lucency is seen around the femoral prosthesis. (b) Fast STIR oblique coronal (3,000/40/100) MR image shows signal intensity in all zones equal to signal intensity in the bone marrow of the distal femur (arrows). (c) T1-weighted SE (340/15) oblique coronal MR image obtained after injection of contrast material. There is no enhancement along the prosthesis (arrows); therefore, all zones show the type III signal intensity pattern. At surgery, the stem was found to be stable and was not revised.

View larger version (83K): [in a new window]   Figure 4b. (a) Anteroposterior radiograph of the right hip in a 64-year-old woman who subsequently underwent revision surgery for osteolysis (arrows) of the acetabulum. A cementless bipolar femoral prosthesis is seen. No sclerosis or lucency is seen around the femoral prosthesis. (b) Fast STIR oblique coronal (3,000/40/100) MR image shows signal intensity in all zones equal to signal intensity in the bone marrow of the distal femur (arrows). (c) T1-weighted SE (340/15) oblique coronal MR image obtained after injection of contrast material. There is no enhancement along the prosthesis (arrows); therefore, all zones show the type III signal intensity pattern. At surgery, the stem was found to be stable and was not revised.

View larger version (81K): [in a new window]   Figure 4c. (a) Anteroposterior radiograph of the right hip in a 64-year-old woman who subsequently underwent revision surgery for osteolysis (arrows) of the acetabulum. A cementless bipolar femoral prosthesis is seen. No sclerosis or lucency is seen around the femoral prosthesis. (b) Fast STIR oblique coronal (3,000/40/100) MR image shows signal intensity in all zones equal to signal intensity in the bone marrow of the distal femur (arrows). (c) T1-weighted SE (340/15) oblique coronal MR image obtained after injection of contrast material. There is no enhancement along the prosthesis (arrows); therefore, all zones show the type III signal intensity pattern. At surgery, the stem was found to be stable and was not revised.