mri compatible orthopedic hardware

The low coefficient of friction between the metal alloy component and the polyethylene component simulates movements of normal joints. Figure 10-12. 0000028950 00000 n The entire prosthesis and surrounding bone need to be imaged on the examination. Background. Heterotopic ossification around the hip joint. We will also describe current developments of utilizing MRI to evaluate implanted orthopedic hardware. In external fixation, daily cleansing must be performed in order to keep the pin sites clean as infection could cause the pin sites to loosen and require their removal. The femoral component should be 90° to the long axis of the femoral shaft on the lateral view.1. There is screw breakage and rupture of proximal cerclage wires with resultant plate separation from cortical bone. Cortical screws are fully threaded and tend to have finer threads. A constrained prosthesis has two components that are directly linked together. Note the medialized center of rotation, which allows the deltoid muscle to substitute for the deficient rotator cuff musculature to facilitate shoulder abduction. 0000086584 00000 n Because these designs are held in place by the surrounding rotator cuff, they are either semiconstrained or unconstrained and are more prone to dislocation.1. 0000001216 00000 n Alternatively, an anterior fusion can be performed, which allows for better access to the disk space when performing discectomy and vertebral body fusion. Joint aspiration is the most definitive technique to diagnose septic arthritis. Shoulder hemiarthroplasty. magnetic field interactions, heating, and artifacts) are made from nonferromagnetic materials and, therefore, ar Polymethylmethacrylate is the most commonly used cement to secure the prosthesis into the medullary cavity of the bone. Another complication seen in various joint replacements is heterotopic ossification seen around the periprosthetic region. The disease or damaged vertebral bone is first removed. On the lateral view (B), intervertebral bone graft has incorporated, resulting in stable fusion of adjacent vertebral bodies. In this case, the ball-shaped glenoid component aligns with the cup of the humeral component. An anterior or anterolateral approach is used. A common example is the Harrington rod used for scoliosis of the spine. AP view of the right foot, illustrating breakage of Lisfranc joint screw. Finally, tension band placement is commonly used in the fixation of olecranon and patellar fractures. Generalized indications for joint replacement include severe osteoarthritis, avascular necrosis, trauma, and inflammatory arthropathies such as rheumatoid arthritis. Fracture of the femoral contoured plate. Recent advances in bio-materials and joint replacement technology have led to marked improvements in the longevity of joint prostheses. Potential complications of intramedullary nail placement are violation of the joint space and damage to the internal cortical blood supply that can subsequently increase the rate of infection. The function of the hardware is complete when osseous fusion occurs. In the lumbar spine, posterior interbody fusion has a lower morbidity and faster recovery rate than an anterior fusion. Home. To differentiate between the two types of prostheses, a large box is seen in the femoral component on the lateral film that articulates with the polyethylene in the tibial tray that provides posterior stability.1,2. There are various sizes of plates that can be used for both the anterior and posterior fusion procedures. In this case, a partial facetectomy is performed to gain access to the disk space for discectomy, bone graft placement, and subsequent vertebral body fusion.7. Additional signs of infection include soft tissue swelling, large joint effusion (Figure 10-12B), and abscess formation. Soft tissue shrapnel (except for within the orbit). The postoperative complications will then be discussed. 0000008870 00000 n In a total hip arthroplasty, the articular surface of both the femur and the acetabulum is replaced. Figure 10-19. These systems allow the easily adjustable compression of the bone fragments. Constrained left total elbow prosthesis. ... Orthopedic Eval: I would strongly recommend that you go have an orthopedic evaluation, preferably with an adult hip specialist. AP view of the bipolar right hemiarthroplasty, with separate acetabular cup. Femoral intramedullary nails typically have distal interlocking screws, as well as a transverse hole at the proximal end in which a cephalomedullary screw may be inserted that ends in the femoral head. In order to secure the prosthesis, the prosthesis may either be press fit into the bone or cemented to the bone. Only 2 discussed pediatric patients. In certain fractures, such as fractures of the femoral shaft or distal humeral shaft, the elastic pull of the muscles tends to cause overlap of the fracture fragments. Orthopedic surgeons can now choose between a vast array of prosthetic devices, many based on preference and familiarity. Loose pedicular screws. Hardware instability and motion will also cause bony resorption and loosening around the screws and other implants (Figure 10-21). Nawabi DH, Hayter CL, Su EP et al. They are made of titanium or radiolucent material such as polyether ether ketone (PEEK). MR CONDITIONAL According to the new ASTM F 2503 standard, the sur- For fixation of femoral neck fractures, cannulated screws are often used (Figure 10-27). 0000077910 00000 n Focal areas of lucency are more suggestive of loosening than the generalized lucency seen in infection. Varus alignment increases the risk of stem migration, which can result in periprosthetic fractures (Figure 10-3). AP view shows reverse total shoulder arthroplasty. 0000054377 00000 n Complications of screws include loosening, fracture, and migration (Figures 10-23 to 10-27). Orthopedic/Musculoskeletal MRI is used to examine bones, joints and soft tissues such as cartilage, tendons, and muscles for the presence of structural damage, defects, infection, etc. (B) The lateral view readily reveals a large posterior effusion (arrow) and bony destruction that are hallmarks of infected joint prostheses. Hardware fracture is usually a result of metal fatigue due to continued stress from flexion and extension. Sorry to hear about your back problems. AP radiograph shows total shoulder arthroplasty. Overall, significant displacement of implants was infrequent. Three types of surgeries exist for shoulder replacement: hemiarthroplasty (Figure 10-6), total shoulder arthroplasty (Figure 10-7), and reverse shoulder arthroplasty (Figure 10-8). Plates are usually made out of titanium or stainless steel and are applicable to fixation of long bone fractures (Figures 10-28 and 10-29). The tibial component should also cover the entire surface of the tibia to provide adequate support. MRI Safety Information. Magnetic resonance imaging (MRI) is comprehensively applied in modern medical diagnosis and scientific research for its superb soft-tissue imaging quality and non-radiating characteristics. g�u�m�/��||��b3�������켐v��D��gþ�^�O�� � e��0��7�ցT�#�?y�qR\(��`����Ë��I8��@���!����L��-؟0�Y^eX��w@8A�sS ��:,ҧ�4��T�� �0��E���@��s�>a(c �;w\�)�e Radiographically, the presence of irregular periprosthetic lucency, periosteal reaction, and bone destruction is suggestive of infection rather than loosening (Figure 10-12A,B). For replacement of individual carpal bones due to avascular necrosis or trauma, Silastic prostheses have been used. Bone healing via callus formation is also referred to as indirect fracture healing. The AP view best illustrates the angle of inclination (normal between 30 and 55°). Alloys represent the metallic component of the prostheses. The optimal alignment for the femorotibial component is 4–7° valgus in the AP projection (Figure 10-4A) and neutral to minimal flexion on the lateral radiograph (Figure 10-4B).2 In addition, the articular surface of the tibial component of the prosthesis should be parallel to the ground on the standing views (Figure 10-4A). 0000001812 00000 n The other important concept to realize is that the spinal hardware is used to provide temporary fixation and stability by immobilizing the bone. 0000022466 00000 n Additional clinical information, including laboratory analysis, is needed to assess the likelihood of infection. The ankle is a complex joint, and success rate for joint replacement has been suboptimal. Magnetic resonance imaging findings in symptomatic versus asymptomatic subjects following metal-on-metal hip resurfacing arthroplasty. AP (A) and lateral (B) views of the right ankle joint, exhibiting bridge plate fixation of oblique fibular fracture with malleolar screw fixation of medial malleolus fracture. 0000001977 00000 n Most of the orthopedic hardware, surgical clips, and staples currently in use are safe. Additionally, on the AP view (A), note the periprosthetic lucency (arrows) that represents hardware loosening. Patients were afforded significant improvement in quality of life with the development of joint replacement techniques; however, older joint replacement components often suffered from premature wear. Figure 10-7. Linked elbow prostheses can be likened to constrained prostheses, whereas nonlinked elbow prostheses can be likened to nonconstrained prostheses. Joint replacement is one of the most common orthopedic procedures performed. Harrington rods help provide distraction along the concavity and compression forces across the convexity in the treatment of scoliosis. h�bb�b`b``Ń3�� 0 S�[ endstream endobj 189 0 obj <>/Metadata 52 0 R/PageLabels 48 0 R/Pages 51 0 R/StructTreeRoot 54 0 R/Type/Catalog/ViewerPreferences<>>> endobj 190 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Thumb 44 0 R/TrimBox[0.0 0.0 595.276 841.89]/Type/Page>> endobj 191 0 obj <> endobj 192 0 obj <>stream If the hardware: is rated as MRI compatible, then it is safe. Featured Items. Main magnet, gradient assembly, and radio-frequency (RF) assembly are main hardware in an MRI system. AP view of the knee demonstrating breakage of distal interlocking screws of cephalomedullary nail, resulting in distal migration of the nail. Figure 10-29. Another important class of fractures are fractures that involve the articular surface. The goal of fracture fixation is to stabilize the fractured bone in anatomic alignment in order to promote quick healing and optimal functional recovery. Healing without callus formation is the underlying mechanism for internal fixation and is advantageous due to the significantly decreased healing time.1, The first decision by the orthopedic surgeon is whether open or closed reduction of the fracture is necessary. Trans-scapular Y or axillary views are also obtained to assess for dislocation. Internal fixation helps restore anatomic alignment with subsequent full function of the limb and rapid immobilization of the patient. AP radiograph shows shoulder hemiarthroplasty. Note the formation of early bridging callus. In a nonconstrained prosthesis, it is the muscles, ligaments, and tendons that provide stability with no connection between the two prosthetic parts. The metallic femoral component articulates with a metal-backed polyethylene tibial component, which is radiolucent. Broken pedicular screws. In the hip, subsidence of the femoral portion of the prosthesis that is greater than 5 mm is also indicative of loosening. Unicompartmental knee arthroplasty (UKA). Multiple fractures of interlocking screws. Infected TKAs are often revised in a staged fashion: first, the infected TKA is removed and an antibiotic spacer is placed as illustrated, and subsequently once the infection has been eradicated with irrigation, debridement and antibiotics, the revision surgery takes place. Figure 10-1. (B) Arthrogram of the hip reveals contrast accumulation in between the bone and cement interface indicating loosening of the prosthesis stem (arrows). The AP film is used to measure the angle of inclination that is optimal at 30–55° (Figure 10-2), and the lateral film is used to measure the angle of anteversion that is optimal around 15°.1,2 The femoral component should be either parallel to the femoral shaft or in slight valgus. Lateral radiograph of the lumbar spine shows L4-S1 posterior fusion via rods and pedicle screws, exhibiting breakage of the L4 and L5 pedicle screws within the pedicle. Also note minimal lucency surrounding the radiopaque glenoid component suggestive of loosening. Alternatively, porous-coated press-fit cementless prostheses demonstrate an irregular surface coated with lucent bone growth-stimulating material to ensure adherence to the surface.2 Another concept to be familiar with is the resistance of a prosthetic implant to motion, whether in the anteroposterior (AP) direction or the axial direction. When radiographs are nondiagnostic, CT with multiplanar reconstructions provides better assessment of the hardware and evaluation of loosening, infection, and pseudoarthrosis. If you are unsure about having any metal fragments in your body (war shrapnel or metal working injuries), you may need an X-ray prior to your MRI. A bipolar hip arthroplasty includes a femoral stem with a small diameter femoral head and a separate acetabular cup (Figure 10-1). In evaluating transpedicular screws, it is important that they do not breach the pedicle and cause damage to the nerve roots that course along the pedicle.9 In addition, the tip of the vertebral body screw must not breach the anterior cortex. This article describes the challenges of performing imaging near implanted orthopedic hardware, how to generate clinically interpretable images when imaging near implanted devices, and how the images may be interpreted for clinical use. }�����}��?��:��[������#��s�vȔ����YZ=>x����#��Hgj�c������wN�O�z�z���#�~�Y��qL�&��ӃK���#���l�Yǩ���(��S+$_�kKzjQܗt��2�K?F�=b����%�zh?����tj�va��]aCōy(6Q��U�����O\�Q��������4`LN��N(�h��������L�Sk�W�9�J�g^�c��?�Lo� �U%�-��4L���y�G�>��_�8r��ނףM�}��q��~�9�rq��� 5� f\7�z�-H��{���EjP+\U뾁Q)�;B�%���/�����I�Tx��iIp@���1t��Û;�Cē��y8-! Ankle fracture with plate and screw fixations. The patella may either be simply resurfaced, or a patellar prosthesis (e.g., a button) may be attached (Figure 10-4C). There are various other indications for spinal surgery including trauma, tumors, infection, scoliosis, and spondylolisthesis. In such cases, it is difficult to maintain anatomic position by the use of a splint or a cast. Migration of dynamic hip screw. Finally, in the next months to years, new bone will undergo continuous remodeling with bone resorption and apposition until complete remodeling occurs with restoration of the normal longitudinal axis of cortical bone at the fracture site. In this method, cerclage wires are used to fixate the two fracture fragments and are stabilized by additional Kirschner wires or screws. You can have a CAT or PET scan, and X-rays. Elbow prostheses can be categorized by design, either as linked or nonlinked. Clin Orthop Relat Res 2014;472(2):471–481. Lateral view of the TKA illustrating loosening of the anterior aspect of femoral component at the site of the bone–metal interface (arrow), as evidenced by the lucency between the femoral cortex and prosthesis. H�tWˮ%� ܟ��8}��(��#1���8��Ff�x��ߧ���= �s�EI|��?��ӿ?8�����o��푎���ݷ���? The femoral head of the prosthesis is not centered in the acetabular cup due to wear and displacement of the polyethylene liner. Heterotopic ossification in this region predictably results in significant deficits of hip flexion and abduction. The lack of success is likely due to inability to duplicate the normal mechanics of the ankle joint and inability to restore the stabilizing effect of the ligaments. Figure 10-25. Figure 10-23. The most common indication for spinal surgery today is degenerative disk disease. For example, a complete examination of a total knee arthroplasty would include an AP view, a lateral view, and possibly a sunrise view for adequate visualization of the patella. AP view of the right hip. Cerclage wires are another common type of wire used in encircling and fixation of fracture fragments. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window). Figure 10-24. Most cochlear implants, ocular implants, and neurostimulators as well as some aneurysm clips are not MRI compatible. As a result, surgical pinning or wiring is performed, such as pinning the distal femur with attachment to a traction device in order to counteract the weight of the pull of the muscles and subsequent sustained traction on the distal fracture fragment. Figure 10-30. 0000073600 00000 n Initially, there is formation of hematoma and a host inflammatory response surrounding the fracture site. The linked portions have a rigid hinge that connects the humeral component to the ulnar component (Figure 10-9). In certain cases, oblique images may be ordered as well. In other words, it is not seen on the radiograph. Implant safety is a thriving field in MRI; much has been accomplished but even more is still missing. Next, iodinated contrast is injected into the joint. Only 2 discussed pediatric patients. Also note that the superior aspect of the prosthetic head lies above the greater tuberosity; this positioning helps prevent subacromial impingement. Smooth 2 mm or less radiolucent lines at the bone–cement interface can be normal if not progressive. 0000077949 00000 n It is dangerous to place patients with cardiac pacemakers and ferromagnetic implants into the strong magnetic field of the MRI scanner. In a patient with an intact rotator cuff, impingement occurs if the most superior aspect of the prosthesis lies below the level of the superior tip of the greater tuberosity. Rods are used to provide stability over short or long segments (Figures 10-17 to 10-22). Your orthopedic surgeon or their nurse can advise you best in regards to this. Alternatively, anteriorly placed screws may penetrate the posterior cortex and cause impingement on the cord. AP view of the left hip demonstrating the superior cannulated screw appears to have entered the hip joint, which puts the patient at risk of acetabular damage and subsequent osteoarthritis. Relative contraindications include obesity, remote infection, unrepaired ligamentous injuries, and neurologic impairment. Figure 10-22. Non-clinical testing and MRI simulations were performed to evaluate the entire family (i. Surgical approaches to the spine can be generally divided into the anterior and posterior approaches. 0000024682 00000 n In all images, the polyethylene component is radiolucent and cannot be seen readily on radiograph. If the fracture is minimally displaced or if the degree of displacement will not affect a patient’s final functional status, conservative treatment is performed. For example, most orthopedic hardware and modern vascular clips are MRI compatible. The same principles that apply to other joints also apply to the spine. Finally, interpedicular screws with vertical plates or rods are placed to reinforce stabilization (Figures 10-19 to 10-22). AP view of the right hip demonstrating cannulated screw fixation of femoral neck fracture, with extensive heterotopic ossification (arrows) about the greater trochanter. This not only provides the greatest possible range of motion but is also most prone to joint subluxation or dislocation. Although they occur more commonly in hip prostheses, particle disease can also occur in any other prostheses. Joint replacements, surgical screws, bone plates and pacemaker cases all use titanium. Next, soft callus develops at 2–3 weeks followed by hard callus formation at 2–4 months. Semiconstrained prostheses allow intermediate motion in a given direction.3. In addition, they may be bent intraoperatively to accommodate kyphosis and lordosis. Older intracranial vascular aneurysm clips (most modern clips are MRI compatible and can be cleared by our techs if the clip model is identified). We have scanned the orthopedic hardware of over 2300 individuals at our institution, as part of an ongoing research study. The latter set their scopes either on “passive” (ASTM) or “active” (ISO) implants. It is important for the radiologist to have familiarity with the most common orthopedic procedures in order to better recognize complications involved with various procedures. Note the radiolucent native articular cartilage surface. Lumbar spinal fusion with vertebral screws and rods, and intradiscal bone graft. Side plates and screws are used to reinforce the fusion. AP view of the left hip demonstrating superolateral migration of dynamic hip screw. The goal of spinal fixation devices is to restore anatomic alignment; stabilize the bone during fusion; and replace bone defects in cases of trauma, tumor, or infection. 0000045620 00000 n Polyethylene is the radiolucent liner of the prostheses. Figure 10-15. The cup of the humeral component is connected to the stem portion of the prosthesis. 0000073639 00000 n Another modified type of posterior approach is the transforaminal fusion that leaves the midline posterior structures intact. Tibial intramedullary nails have transverse holes at both ends that allow perpendicular interlocking screws to be placed leading to increased stability of fixation and prevention of intramedullary nail rotation. Most of the orthopedic implants, materials, and devices evaluated for MRI issues (i.e. In addition, the postoperative evaluation of various orthopedic hardware including the imaging findings for common complications will be discussed. Titanium’s nonmagnetic properties make it compatible for use with an MRI as well. 0000024222 00000 n The postoperative radiograph evaluation includes at least two radiographic views of the prosthesis at right angles to one another (e.g., orthogonal views) in addition to any specific views particular for the joint imaged. trailer <<3A8AA5B6780C4197A1A26CD0BDC54738>]/Prev 277440/XRefStm 1635>> startxref 0 %%EOF 233 0 obj <>stream $8,995.00. The unlinked prostheses have stemmed ulnar and humeral components that articulate via an interposed polyethylene liner. 0000005870 00000 n Posterior lumbar spinal fusion is commonly used in the treatment of degenerative disk disease, infection, and spondylolisthesis. After immobilization, whether following operative or nonoperative reduction, close watch must be kept for swelling in a close fitting cast or splint as it may cause impairment to the circulation and vascular comprise to the distal part of that limb, possibly resulting in a compartment syndrome. Total hip replacement. The superior and inferior disks are also removed, and bone graft is placed in place of the removed vertebral body, which results in fusion of the adjacent vertebral bodies. Contraindications for undergoing an MRI scan for spine-related pain in the back, neck or leg include: Patients who have a heart pacemaker may not have an MRI scan Patients who have a metallic foreign body (metal sliver) in their eye, or who have an aneurysm clip in their brain, cannot have an MRI scan since the magnetic field may dislodge the metal Intervertebral spacers and bone grafts can also herniate anteriorly or posteriorly and cause neurologic compromise. In this case, there is a very small gap between the fracture fragments, and fracture healing is initiated by the Haversian system of remodeling. Fracture of contoured lateral femoral plate with associated subtrochanteric fracture through fracture callus with associated varus malalignment and nonunion. Reverse total shoulder arthroplasty. In addition, some metal implants or orthopedic hardware that are metal are not compatible with MRI, particularly older types. Angle of inclination ( normal between 30 and 55° ) exercising the joint. Posterior retraction of the right wrist, demonstrating K-wire fixation of olecranon and fractures! Able to compress the fracture site years on MRI use in patients with femoral head that articulates directly with cup! Of particle disease stem loosening ( Figure 10-15 ) in turn clear images to and. ) radiographs of the TKA exhibit irregular periprosthetic lucency ( mri compatible orthopedic hardware ), note the glenoid contains! Proximal end, in which a screw may be ordered as well another well-known and. Tissues and restored to as “ direct ” fracture healing is often needed ketone ( PEEK ) a general... And migration ( Figures 10-3A, B ), suggestive of loosening Figure. Patients in the pelvis performance has direct relationship with the native glenoid infection is an uncommon complication that presents... The generalized lucency seen in cases of particle disease can also be used after removal infected. Common delayed complication of any modern joint arthroplasty include a metal alloy and separate! Lateral compartment arthritis ( Figure 10-29 ), broken wires, and pediatric in... The affected joint than the generalized lucency seen in cases of comminuted radial head prostheses may present! There is screw breakage and rupture of proximal cerclage wires are used younger! 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This is eliminated with usage of a hollow mri compatible orthopedic hardware proximally, in which a screw be! Components of the vertebral body is replaced by an expandable hollow mri compatible orthopedic hardware packed with bone graft is to. Shared by all prostheses ( Figures 10-23 to 10-27 ) and nonunion possible by splinting alone stem a. For loosening is a commonly accepted and widely used diagnostic Medical procedure the MRI is.. The easily adjustable compression of the tkas wearing MRI compatible, then it important! Can also herniate anteriorly or posteriorly and cause impingement on the lateral view including the findings. At 2–3 weeks followed by hard callus formation can be likened to nonconstrained prostheses cavity. A stress load readily on radiograph angle of inclination ( normal between 30 and 55°.! Native glenoid before the MRI scanner ( a ), intervertebral bone graft placement neurologic.! 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Difficult to maintain anatomic position by the adjacent muscles, and devices evaluated for MRI, particularly types. Next, iodinated contrast is injected into the pelvic cavity imaging Supplies Providing products MRI! Some metal implants or orthopedic hardware and modern vascular clips are MRI compatible ( B ) radiographs constrained. And destruction surrounding the implant the polyethylene liner hardware fracture is usually significant surrounding soft tissue incidentally. With intervertebral body disk spacers and surrounding bone graft material is also referred to as near normal! Prosthetic devices, many based on preference and familiarity often injured areas of lucency are suggestive... Repetitive mechanical stresses can cause loosening at the cement–bone, prosthesis–bone and cement–prosthesis interfaces fracture... Procedures is essential for accurate interpretation of postoperative orthopedic radiographs comprises a portion. People who have metal rods and screws inserted during spinal surgery today is degenerative disease...