Saturday, June 11, 2011

What do plain radiographs, ultrasound, MRI and CT offer the Depuy hip patient (6 of 7)

from 6/4 post-Metal on Metal Bearings, The Evidence So Far

1.  Imaging plays an important role in aiding of the diagnosis of early implant failure and soft-tissue complications.

2.  The authors are unaware of any published literature quoting the sensitivity and specificity of the different modalities in relation  to the diagnosis of adverse metal reactions and implant failure.
[added by Connie-I think Hollis Potter MD-Hospital of Special Services has a number of videos on the merits of using  MARS MRIs over other methods as a diagnostic aid that is far superior- with the right protocol-to other methods mentioned here. In fact, the two videos which I have blogged and summarized are two of the highest trafficked blogs on this site. Type in Hollis Potter in the blog landing page search box or you can go to:  Using MRI’s with an optimized protocol to detect metal debris by Hollis Potter MD ]

3.  All modalities mentioned above can be used to add value.  It is a function of what you are trying to discover.

4.  Plain radiographs (xrays) may be used to define the position of the implant.
  • Advantages: 
    • low radiation
    • high availability of the xray
  • Disadvantages
    • can't see soft tissue damage
    • validity of a plain radiograph may be compromised by the large metal heads because the acetabular rim is obscured.
5.  3 dimensional CT might also have an important role
  • [Added by Connie as the disadvantages aren't listed-radiation exposure is higher in CT scans. Radiation levels are higher with CTs.]
6.  MARS MRI may be useful in delineating  soft-tissue abnormalities and mass lesions when plain x-rays are normal. Because of metal artifacts, small lesions may be overlooked. [see my comment above on the MRI protocols.]

7.  Ultrasound may be useful when small underlying soft tissue lesions are suspected.


  1. Hi Connie,
    A question for the hip guru. For those that have a pinnacle hip that have lost their health insurance, are there any options you know of to get the surgery done without a recall happening? Assuming of course metallosis findings and being visibly symptomatic. Attorneys (at least mine) seem to want the revision done or scheduled prior to filing suit to make sure there are no complications, but with no health insurance or Depuy coughing up the cash how do you get it done? I am assuming Depuy would be admitting guilt by reimbursing the cost of surgery. Is my attorney giving me good advice by saying I have to wait prior to filing suit?
    You seem to do such a good job informing us about the hip world, I thought I would give it a try that you might have an idea what the hopelessly uninsured symptomatic Pinnacle recipients could do to get help. Thanks so much, Connie. Hopefully soon you will get a law degree so you can make lots of money for all of your hip knowledge.
    P.S. I may have missed it on your blog, but do you know of any stats on the success of MOM revisions?

  2. Hello,

    I honestly do not know what you would do without insurance. What I would suggest is to contact a few attornies on the list i published earlier in the year and get thier opinions. I have spoken with all of them but one and I have found them all to be very knowledgeable and helpful. That is what I would do were I in your position. It never hurts to ask your question to 3 or 4 attornies.

    Depuy is underwriting surgeries now. I beleive they have tightened up the guidelines who is elegible for surgery. Generally, you go through the insurance company and they subrogate the claims to Depuy at some point.

    The other suggestion is you could call Depuy but if you are already represented, they are unlikely to speak to you.

    In terms of your question about the success of MOM revisions,there are many articles on this however, the studies are related to specific implants. you can look at this list of 16 results in pub med:


  3. Thanks for your answer and the link, Connie. I really appreciate it!