Imaging Metal-on-Metal Hip Replacements: the Norwich Experience

HSS Journal: Volume 9 Issue 3

Marianna S. Thomas, FRCR
Department of Radioloy, Norfolk & Norwich University Hospitals NHS Trust, Norwich, UK

James A. Wimhurst, FRCS(Orth)
Department of Orthopaedics, Norfolk & Norwich University Hospitals NHS Trust, Norwich, UK

John F. Nolan, FRCS(Orth)
Department of Orthopaedics, Norfolk & Norwich University Hospitals NHS Trust, Norwich, UK

Andoni P. Toms, FRCR, PhD
Radiology Academy, Cotman Centre, Colney Lane, Norwich, UK



Adverse reaction to metal debris is a relatively recently described and often a silent complication of metal-on-metal (MOM) total hip replacements (THR). The Norfolk & Norwich University Hospital has been performing metal artefact reduction (MARS) MRI for 8 years in a variety of different types of MOM THR.


The aims of this review are to describe the experience of using MARS MRI in Norwich and to compare our experience with that published by other groups.


A MEDLINE keyword search was performed for studies including MRI in MOM THR. Relevant publications were reviewed and compared with published data from the Norfolk & Norwich University Hospital. The similarities and differences between these data were compared and possible explanations for these discussed.


MARS MRI appears to be the most useful tool for diagnosing, staging and monitoring adverse reactions to metal debris (ARMD). There appears to be no clinically useful association between clinical and serological markers of disease and the severity of MR findings. Although severe early ARMD is associated with significant morbidity, mild disease is often stable for years. If patients with normal initial MR examinations develop ARMD, this usually occurs 7 years. A 1-year interval between MRI examinations is reasonable in asymptomatic patients.


There is a general international consensus that ARMD is prevalent in symptomatic and asymptomatic patients with MOM THR and that while appearances vary with the type of prosthesis, there are characteristic features that make MARS MRI essential for diagnosis, staging and surveillance of the disease.

This article appears in HSS Journal: Volume 9 Issue 3.
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About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


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