RESULTS: Twenty-six (31%) asymptomatic patients had ALTR lesions, all of which were in the greater trochanteric area. Most lesions in symptomatic patients also were in that location, but there was more diversity of location in this group. The cup position among patients with ALTRs was generally good; the average abduction angle for the asymptomatic patients with ALTRs was 40°. In 24 (92%) and 22 (85%) of 26 asymptomatic patients with ALTRs, respectively, chromium and cobalt levels were below the 7-ppb threshold.
CONCLUSIONS: A 31% incidence of periarticular fluid collections in asymptomatic patients with modular MOM THAs is alarming and calls into question any algorithmic approach dependent on symptomatology. The presence of pain was insufficient to identify patients at risk for ALTRs. To determine whether routine cross-sectional imaging of all asymptomatic patients with MOM implants is necessary will require a larger study cohort, longer followup, and clearer understanding of the natural history of periarticular lesions in these patients.
LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
PMID: 23963703 [PubMed - as supplied by publisher]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23963703?dopt=Abstract
