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Multicenter Study
. 2010 Dec;468(12):3278-85.
doi: 10.1007/s11999-010-1361-1.

Early reactive synovitis and osteolysis after total hip arthroplasty

H John Cooper  1 , Amar S Ranawat, Hollis G Potter, Li Foong Foo, Trevor W Koob, Chitranjan S Ranawat
Affiliations
Multicenter Study

Early reactive synovitis and osteolysis after total hip arthroplasty

H John Cooper et al. Clin Orthop Relat Res. 2010 Dec.

Abstract

Background: Little is known about intraarticular pathology following THA prior to the radiographic appearance of osteolysis, primarily due to imaging limitations. MRI has recently been applied to imaging the postarthroplasty hip with the ability to detect periarticular bony and soft tissue pathology; specifically, it is able to detect abnormal synovial patterns and focal bone loss well before the radiographic appearance of osteolysis.

Questions/purposes: We therefore used MRI to determine the incidence of early reactive synovitis and osteolysis in asymptomatic patients after THA, and whether there is an association between these MRI findings and clinical outcomes or radiographic wear measurements at this early stage.

Methods: We recruited 31 patients (33 hips) who underwent routine noncemented THA with one of three types of bearing surfaces: metal-on-cross-linked polyethylene (n = 7), ceramic-on-ceramic (n = 12), and ceramic-on-cross-linked polyethylene (n = 14). Patients underwent specialized MRI at a minimum of 12 months (mean, 23 months; range, 12-37 months) after surgery. MR images were analyzed for the presence of synovitis or osteolysis. WOMAC scores, patient assessment questionnaires, and radiographic wear measurements were correlated with MRI findings.

Results: Reactive synovitis was observed in 13 of 33 patients (39%) and focal osteolysis in one of 33 (3%). The presence of synovitis did not correlate with pain, activity level, patient satisfaction or clinical outcome scales, nor did it correlate with radiographic wear measurements at early followup.

Conclusions: Our observations suggest reactive synovitis is common yet asymptomatic at short-term followup. We do not know either the etiology or the long-term implications of these observations.

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Figures

Fig. 1
Fig. 1
This coronal MR image of a hip arthroplasty demonstrates intermediate signal intensity within the synovial lining and a moderately distended hip joint (arrow), consistent with synovitis.
Fig. 2
Fig. 2
This sagittal MR image of a hip arthroplasty demonstrates a small amount of bone resorption around the acetabular component (arrow) in the posterior column of the acetabulum, without cortical penetration into the pelvis
See this image and copyright information in PMC

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