Development and first validation of a simplified CT-based classification system of soft tissue changes in large-head metal-on-metal total hip replacement: intra- and interrater reliability and association with revision rates in a uniform cohort of 664 ar

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• 作者：Martijn F. Boomsma ; Mireille A. Edens ; Christiaan P. Van Lingen…
• 关键词：Computed tomography ; Metal ; on ; metal total hip arthroplasty ; Classification ; Pseudotumor ; Hip capsule ; Revision
• 刊名：Skeletal Radiology
• 出版年：2015
• 出版时间：August 2015
• 年：2015
• 卷：44
• 期：8
• 页码：1141-1149
• 全文大小：511 KB
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  2.Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Maas M, Verheyen CC. High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. J Bone Joint Surg (Br). 2012;94(6):755-1.View Article
  3.Ollivere B, Darrah C, Barker T, Nolan J, Porteous MJ. Early clinical failure of the Birmingham metal-on-metal hip resurfacing is associated with metallosis and soft-tissue necrosis. J Bone Joint Surg (Br). 2009;91(8):1025-0.View Article
  4.Bisschop R, Boomsma MF, Van Raay JJ, Tiebosch AT, Maas M, Gerritsma CL. High prevalence of pseudotumors in patients with a Birmingham hip resurfacing prosthesis: a prospective cohort study of one hundred and twenty-nine patients. J Bone Joint Surg Am. 2013;95(17):1554-0.PubMed View Article
  5.Gill IP, Webb J, Sloan K, Beaver RJ. Corrosion at the neck-stem junction as a cause of metal ion release and pseudotumour formation. J Bone Joint Surg (Br). 2012;94(7):895-00.View Article
  6.Cook RB, Bolland BJ, Wharton JA, Tilley S, Latham JM, Wood RJ. Pseudotumour formation due to tribocorrosion at the taper interface of large diameter metal on polymer modular total hip replacements. J Arthroplasty. 2013;28(8):1430-.PubMed View Article
  7.Daniel J, Holland J, Quigley L, Sprague S, Bhandari M. Pseudotumors associated with total hip arthroplasty. J Bone Joint Surg Am. 2012;94(1):86-3.PubMed View Article
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  9.Medicines and Healthcare Products Regulatory Agency (MHRA). Medical device alert: all metal-on-metal (MoM) hip replacements. 2013;2013(02 Sept):2012.?Available from:?http://?www.?fda.?gov/?MedicalDevices/?ProductsandMedic?alProcedures/?ImplantsandProst?hetics/?MetalonMetalHipI?mplants/?ucm241604.?htm . Accessed 10 Apr 2015.
  10.U.S. Food and Drug Administration. Metal-on-metal hip implants. 2013.?Available from:?http://?www.?fda.?gov/?MedicalDevices/?Safety/?AlertsandNotices-?ucm335775.?htm . Accessed 3 Jun 2014.
  11.Boomsma MF, Ettema HB, Van Der Straeten C. The use of computerized tomography to evaluate hip resurfacing. In: De Smet K, Campbell P, Van Der Straeten C, editors. The hip resurfacing handbook. A practical guide to the use and management of modern hip resurfacings. 1st ed. Cambridge: Woodhead Publishing Limited; 2013. p. 233-3.
  12.Fujishiro T, Moojen DJ, Kobayashi N, Dhert WJ, Bauer TW. Perivascular and diffuse lymphocytic inflammation are not specific for failed metal-on-metal hip implants. Clin Orthop Relat Res. 2011;469(4):1127-3.PubMed Central PubMed View Article
  13.Peters A, Tillmann B. Bursa iliopectinea–size and morphology. Anat Anz. 1988;167(5):403-.PubMed
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  16.Bosker BH, Ettema HB, van Rossum M, et al. Pseudotumor formation and serum ions after large-head metal-on-metal stemmed total hip replacement: risk factors, time course and revisions in 706 hips. Arch Orthop Trauma Surg. 2015;135(3):417-5.PubMed View Article
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• 作者单位：Martijn F. Boomsma (1)
  Mireille A. Edens (2)
  Christiaan P. Van Lingen (3)
  Niek Warringa (1)
  Harmen B. Ettema (3)
  Cees C. P. M. Verheyen (3)
  Mario Maas (4)
  
  1. Department of Radiology, Isala Hospital, Zwolle, The Netherlands
  2. Department of Innovation and Science, Isala Hospital, Zwolle, The Netherlands
  3. Department of Orthopaedics, Isala Hospital, Zwolle, The Netherlands
  4. Department of Radiology, AMC, Amsterdam, The Netherlands
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Imaging and Radiology
  Orthopedics
  Pathology
  Nuclear Medicine
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-2161

文摘

Objective After implantation of a metal-on-metal total hip arthroplasty (MoM THA), a large incidence of pseudotumor formation has been described recently. Several centers have invited patients for follow-up in order to screen for pseudotumor formation. The spectrum of abnormalities found by CT in MoM THA patients can be unfamiliar to radiologists and orthopedic surgeons. Previously, a CT five-point grading scale has been published. In this paper, a simplification into a three-point classification system gives insight in the morphological distinction of abnormalities of the postoperative hip capsule in MoM implants in relation to the decision for revision. The reliability of this simplified classification regarding intra- and interrater reliability and its association with revision rate is investigated and discussed. Materials and methods All patients who underwent MoM THA in our hospital were invited for screening. Various clinical measures and CT scan were obtained in a cross-sectional fashion. A decision on revision surgery was made shortly after screening. CT scans were read in 582 patients, of which 82 patients were treated bilaterally. CT scans were independently single read by two board-certified radiologists and classified into categories I–V. In a second meeting, consensus was obtained. Categories were subsequently rubricated in class A (categories I and II), B (category III), and C (categories IV and V). Intra- and inter-radiologist agreement on MoM pathology was assessed by means of the weighted Cohen’s kappa. Categorical data were presented as n (%), and tested by means of Fisher’s exact test. Continuous data were presented as median (min–max) and tested by means of Mann–Whitney U test (two group comparison) or Kruskal–Wallis test (three group comparison). Logistic regression analysis was performed in order to study independence of CT class for association with revision surgery. Univariate statistically significant variables were entered in a multiple model. All statistical analysis was performed two-tailed using alpha 5?% as the significance level. Results In total, 664 scores from 664 MoM hips obtained by two observers were available for analyses. Interobserver reliability for the non-simplified version (I–V) was κw--.71 (95?% CI: 0.62-.79), which indicates good agreement between the two musculoskeletal radiologists. Intra- and interobserver reliability for the simplified version (A–C) were respectively κw 0.78 (95?% CI: 0.68-.87), and κw--.71 (95?% CI: 0.65-.76). This indicates good agreement within and between the two observers. The simplified A–C version is significantly associated with revision exclusively due to MoM pathology, in both patients with unilateral MoM THA (p-lt;-.001) and patients with bilateral MoM THA (p-lt;-.044). The simplified A–C version is associated with several clinical measures. In patients with unilateral MoM THA, with or without contralateral THA, in situ time (p-lt;-.008), cobalt and chromium (p-lt;-.001) were statistically significant. In patients with bilateral MoM, cobalt (p-lt;-.001) and chromium (p-lt;-.027) were statistically significant. Revision is significantly associated with cup size (p-lt;-.001), anteversion of the cup (p-lt;-.004), serum ion levels of cobalt and chromium (p-lt;-.001) and the adapted classification system (p-lt;-.001). In univariate logistic regression analysis on revision, cup, anteversion of the cup, cobalt–chromium ion serum levels, and the simplified (A–C) CT category system were statistically significant. The simplified (A–C) CT category system was an independent associate of revision, in several multiple logistic regression models. Conclusions The presented simplified CT grading system (A–C) in its first clinical validation on 48- and 64-multislice systems is reliable, showing good intra- and interrater reliability and is independently associated with revision surgery.