MRI Findings at the Bone-Component Interface in Symptomatic Unicompartmental Knee Arthroplasty and the Relationship to Radiographic Findings

Abstract

Background

The most common modes of failure of cemented unicompartmental knee arthroplasty (UKA) designs are aseptic loosening and unexplained pain at short- to mid-term follow-up, which is likely linked to early fixation failure. Determining these modes of failure remains challenging; conventional radiographs are limited for use in assessing radiolucent lines, with only fair sensitivity and specificity for aseptic loosening.

Questions/Purposes

We sought to characterize the bone-component interface of patients with symptomatic cemented medial unicompartmental knee arthroplasty (UKA) using magnetic resonance imaging (MRI) and to determine the relationship between MRI and conventional radiographic findings.

Methods

This retrospective observational study included 55 consecutive patients with symptomatic cemented UKA. All underwent MRI with addition of multiacquisition variable-resonance image combination (MAVRIC) at an average of 17.8 ± 13.9 months after surgery. MRI studies were reviewed by two independent musculoskeletal radiologists. MRI findings at the bone-cement interface were quantified, including bone marrow edema, fibrous membrane, osteolysis, and loosening. Radiographs were reviewed for existence of radiolucent lines. Inter-rater agreement was determined using Cohen's κ statistic.

Results

The vast majority of symptomatic UKA patients demonstrated bone marrow edema pattern (71% and 75%, respectively) and fibrous membrane (69% and 89%, respectively) at the femoral and tibial interface. Excellent and substantial inter-rater agreement was found for the femoral and tibial interface, respectively. Furthermore, MRI findings and radiolucent lines observed on conventional radiographs were poorly correlated.

Conclusion

MRI with the addition of MAVRIC sequences could be a complementary tool for assessing symptomatic UKA and for quantifying appearances at the bone-component interface. This technique showed good reproducibility of analysis of the bone-component interface after cemented UKA. Future studies are necessary to define the bone-component interface of symptomatic and asymptomatic UKA patients.