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MRI Comparison of Periprosthetic Structures Around Zirconium Knee Prostheses and Cobalt Chrome Prostheses

Brad Raphael1, Andrew H. Haims1, Jim S. Wu1, Lee D. Katz1, Lawrence M. White2 and Kevin Lynch3

1 Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St., PO Box 20804, New Haven, CT 06520-8042.
2 Department of Medical Imaging, Mt. Sinai Hospital and the University Health Network, Toronto, ON, Canada.
3 Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.


Figure 1
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  		Fig. 1A —Femoral component of prostheses. 62-year-old woman with zirconium prosthesis. Axial fast spin-echo T2-weighted MR image shows reduced metal susceptibility artifact. Bone prosthesis interface (arrows) of femoral component is evident.

 

Figure 2
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  		Fig. 1B —Femoral component of prostheses. 63-year-old woman with cobalt chrome prosthesis. Axial fast spin-echo T2-weighted MR image shows extensive periprosthetic metallic susceptibility artifact. Bone-cement interface (arrows) of posterior flange of femoral component is markedly obscured.

 

Figure 3
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  		Fig. 2A —Femoral and patellar components of prostheses. 53-year-old woman with zirconium prosthesis. Sagittal proton density-weighted MR image shows reduced metal susceptibility artifact. Quadriceps tendons (white arrows), bone-prosthesis interface (black arrows) of femoral component, and bone interface (arrowheads) with patellar component are evident.

 

Figure 4
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  		Fig. 2B —Femoral and patellar components of prostheses. 63-year-old woman with cobalt chrome prosthesis. Sagittal proton density-weighted MR image shows extensive periprosthetic metallic susceptibility artifact. Quadriceps tendons and suprapatellar recess (white arrows), bone-prosthesis interface (black arrows) of femoral component, and patellar component (arrowheads) are markedly obscured by metal artifact.

 

Figure 5
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  		Fig. 3A —Medial collateral ligament. 61-year-old man with zirconium prosthesis. Coronal T2-weighted MR image shows reduced metal susceptibility artifact. Medial collateral ligament (arrows) is evident through its entire course.

 

Figure 6
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  		Fig. 3B —Medial collateral ligament. 55-year-old man with cobalt chrome prosthesis. Coronal T2-weighted MR image shows extensive periprosthetic metal artifact. This metal artifact obscures medial collateral ligament (arrows) at level of joint line.

 

Figure 7
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  		Fig. 4 —46-year-old woman with zirconium prosthesis. Sagittal proton density-weighted MR image shows completely torn and retracted quadriceps tendon (arrows).

 

Figure 8
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  		Fig. 5A —63-year-old woman with cystic changes along bone-prosthesis interface and loosening of polyethylene patellar component from zirconium prosthesis. Axial fast spin-echo T2-weighted MR image shows cystic changes (arrows) along bone-prosthesis interface.

 

Figure 9
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  		Fig. 5B —63-year-old woman with cystic changes along bone-prosthesis interface and loosening of polyethylene patellar component from zirconium prosthesis. Axial STIR MR image at same level as A. Arrows show cystic changes along bone-prosthesis interface.

 

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