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Gluteal muscle fatty atrophy is not associated with elevated blood metal ions or pseudotumors in patients with a unilateral metal-on-metal hip replacement.

Reito A, Elo P, Nieminen J, Puolakka T, Eskelinen A - Acta Orthop (2015)

Bottom Line: Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI.A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare.However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach.

View Article: PubMed Central - PubMed

Affiliation: a Coxa Hospital for Joint Replacement , Tampere , Finland .

ABSTRACT

Background and purpose: There are no international guidelines to define adverse reaction to metal debris (ARMD). Muscle fatty atrophy has been reported to be common in patients with failing metal-on-metal (MoM) hip replacements. We assessed whether gluteal muscle fatty atrophy is associated with elevated blood metal ion levels and pseudotumors.

Patients and methods: 263 consecutive patients with unilateral ASR XL total hip replacement using a posterior approach and with an unoperated contralateral hip were included in the study. All patients had undergone a standard screening program at our institution, including MRI and blood metal ion measurement. Muscle fatty atrophy was graded as being absent, mild, moderate, or severe in each of the gluteal muscles.

Results: The prevalence of moderate-to-severe gluteal muscle atrophy was low (12% for gluteus minimus, 10% for gluteus medius, and 2% for gluteus maximus). Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI. A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare. Multivariable regression revealed that "preoperative diagnosis other than osteoarthrosis" was the strongest predictor of the presence of fatty atrophy.

Interpretation: Gluteal muscle atrophy may be a clinically significant finding with influence on hip muscle strength in patients with MoM hip replacement. However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach.

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Related in: MedlinePlus

Venn diagrams showing the overlapping of findings of interest in patients with moderate-to-severe g. minimus atrophy (left panel) and with moderate-to-severe g. medius atrophy (right panel). Patients with moderate-to-severe g. maximus atrophy are not shown because of the very low prevalence.
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Figure 0005: Venn diagrams showing the overlapping of findings of interest in patients with moderate-to-severe g. minimus atrophy (left panel) and with moderate-to-severe g. medius atrophy (right panel). Patients with moderate-to-severe g. maximus atrophy are not shown because of the very low prevalence.

Mentions: It was rare to have a combination of all 3 findings of interest (moderate-to-severe gluteal atrophy, elevated WB Cr and Co levels, and mixed-type or solid-type PT) (Figure 5). The most common combination of abnormal findings was elevated blood metal ions and mixed-type or solid-type PT in MRI. In most of the patients, however, each of the abnormal findings was seen to be unrelated to other findings.Figure 5.


Gluteal muscle fatty atrophy is not associated with elevated blood metal ions or pseudotumors in patients with a unilateral metal-on-metal hip replacement.

Reito A, Elo P, Nieminen J, Puolakka T, Eskelinen A - Acta Orthop (2015)

Venn diagrams showing the overlapping of findings of interest in patients with moderate-to-severe g. minimus atrophy (left panel) and with moderate-to-severe g. medius atrophy (right panel). Patients with moderate-to-severe g. maximus atrophy are not shown because of the very low prevalence.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940588&req=5

Figure 0005: Venn diagrams showing the overlapping of findings of interest in patients with moderate-to-severe g. minimus atrophy (left panel) and with moderate-to-severe g. medius atrophy (right panel). Patients with moderate-to-severe g. maximus atrophy are not shown because of the very low prevalence.
Mentions: It was rare to have a combination of all 3 findings of interest (moderate-to-severe gluteal atrophy, elevated WB Cr and Co levels, and mixed-type or solid-type PT) (Figure 5). The most common combination of abnormal findings was elevated blood metal ions and mixed-type or solid-type PT in MRI. In most of the patients, however, each of the abnormal findings was seen to be unrelated to other findings.Figure 5.

Bottom Line: Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI.A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare.However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach.

View Article: PubMed Central - PubMed

Affiliation: a Coxa Hospital for Joint Replacement , Tampere , Finland .

ABSTRACT

Background and purpose: There are no international guidelines to define adverse reaction to metal debris (ARMD). Muscle fatty atrophy has been reported to be common in patients with failing metal-on-metal (MoM) hip replacements. We assessed whether gluteal muscle fatty atrophy is associated with elevated blood metal ion levels and pseudotumors.

Patients and methods: 263 consecutive patients with unilateral ASR XL total hip replacement using a posterior approach and with an unoperated contralateral hip were included in the study. All patients had undergone a standard screening program at our institution, including MRI and blood metal ion measurement. Muscle fatty atrophy was graded as being absent, mild, moderate, or severe in each of the gluteal muscles.

Results: The prevalence of moderate-to-severe gluteal muscle atrophy was low (12% for gluteus minimus, 10% for gluteus medius, and 2% for gluteus maximus). Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI. A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare. Multivariable regression revealed that "preoperative diagnosis other than osteoarthrosis" was the strongest predictor of the presence of fatty atrophy.

Interpretation: Gluteal muscle atrophy may be a clinically significant finding with influence on hip muscle strength in patients with MoM hip replacement. However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach.

Show MeSH
Related in: MedlinePlus