What is appropriate surveillance for metal-on-metal hip arthroplasty patients?

Figures & data

Summary of studies comparing ultrasound and MARS-MRI for detecting adverse reactions to metal debris and pseudotumors

			Positive	Negative
	Sensitivity	Specificity	predictive	predictive
Study (participants)	(%)	(%)	value (%)	value (%)
Garbuz et al. 2014 (40 hips)
Ultrasound vs. MARS-MRI^a	100	96	92	100
MARS-MRI vs. ultrasound^a	92	100	100	96
Siddiqui et al. 2014 (19 hips)
Ultrasound vs. MARS-MR^a	69	83	90	56
Nishii et al. 2014 (64 hips)
Ultrasound vs. MARS-MRI^a	74	92	NS	NS
Muraoka et al. 2015 (83 hips)
Ultrasound vs. MARS-MRI^a	72	88	65	91
Kwon et al. 2016a (42 hips)
Initial: Ultrasound vs. MARS-MRI^a	81	92	86	88
Repeat: Ultrasound vs. MARS-MRI^a	86	88	75	94
Matharu et al. 2016e (40 hips)
Ultrasound vs. intraoperative^a	91	43	88	50
MARS-MRI vs. intraoperative^a	94	57	91	67
Combined imaging (ultrasound & MARS-MRI) vs. intraoperative^a	100	57	92	100

NS = not stated.

a Gold reference standard for diagnostic test characteristics

Pseudotumor in association with a metal-on-metal hip resurfacing arthroplasty identified on ultrasound examination. Anterior view of the hip demonstrating an enlarged mixed pseudotumor lying in the psoas bursa region. The pseudotumor lies in close proximity to the femoral vessels (marked) and has a smaller medial (M) and a larger lateral (L) component.

Garbuz D S, Hargreaves B A, Duncan C P, Masri B A, Wilson D R, Forster B B. The John Charnley Award: Diagnostic accuracy of MRI versus ultrasound for detecting pseudotumors in asymptomatic metal-on-metal THA. Clin Orthop Relat Res 2014; 472 (2): 417–23.

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Siddiqui I A, Sabah S A, Satchithananda K, Lim A K, Cro S, Henckel J, Skinner J A, Hart A J. A comparison of the diagnostic accuracy of MARS MRI and ultrasound of the painful metal-on-metal hip arthroplasty. Acta Orthop 2014; 85 (4): 375–82.

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Nishii T, Sakai T, Takao M, Yoshikawa H, Sugano N. Is ultrasound screening reliable for adverse local tissue reaction after hip arthroplasty? J Arthroplasty 2014; 29 (12): 2239–44.

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Muraoka K, Naito M, Nakamura Y, Hagio T, Takano K. Usefulness of ultrasonography for detection of pseudotumors after metal-on-metal total hip arthroplasty. J Arthroplasty 2015; 30 (5): 879–84.

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Kwon Y M, Dimitriou D, Liow M H, Tsai T Y, Li G. Is ultrasound as useful as metal artifact reduction sequence magnetic resonance imaging in longitudinal surveillance of metal-on-metal hip arthroplasty patients? J Arthroplasty 2016a; 31 (8): 1821–7.

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Matharu G S, Mansour R, Dada O, Ostlere S, Pandit H G, Murray D W. Which imaging modality is most effective for identifying pseudotumours in metal-on-metal hip resurfacings requiring revision: Ultrasound or MARS-MRI or both? Bone Joint J 2016e; 98-B (1): 40–8.

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