MRI Characteristics of Adverse Local Tissue Reactions Associated With Intraoperative Tissue Damage and Poor Revision Surgery Outcomes: A Systematic Review

J Am Acad Orthop Surg. 2021 Oct 15;29(20):e1025-e1033. doi: 10.5435/JAAOS-D-20-00793.


Background: Metal artifact reductions sequence (MARS) MRI has been established as a cross-sectional imaging modality for diagnosis of adverse local tissue reaction (ALTR). This study aims to evaluate the current literature regarding the characteristics of MARS MRI associated with intraoperative tissue necrosis and postoperative complications in patients undergoing revision THA because of ALTR.

Methods: We systematically searched the literature that included reporting MRI characteristics of ALTR in failed THA and their correlation with intraoperative findings and postoperative outcomes.

Results: A total of 617 studies were assessed, and 15 studies met the inclusion criteria. Synovial wall thickness correlated with increasing ALVAL grade, however, weakly with tissue necrosis. Synovial composition of mixed or solid features and the presence of abductor disruption correlated with complications and tissue necrosis. Tissue edema was a poor predictor of aseptic lymphocyte-dominant vasculitis-associated lesion (ALVAL) grade or tissue necrosis.

Discussion: MARS MRI synovial composition including mixed and solid features and the presence of abductor disruption provide the best prognostic characteristics associated with intraoperative soft-tissue necrosis and revision surgery outcome. These prognostic characteristics on MRI may assist surgeons with improved criteria for intervention and preoperative patient counseling.

Publication types

  • Systematic Review

MeSH terms

  • Arthroplasty, Replacement, Hip*
  • Hip Prosthesis*
  • Humans
  • Magnetic Resonance Imaging
  • Metal-on-Metal Joint Prostheses*
  • Prosthesis Design
  • Prosthesis Failure
  • Reoperation