Innovative Mri Technique Helps Identify Mystery Knee Pain Following Knee Replacement
The Huffington Post
Recently, a police officer underwent two surgeries including a partial knee replacement. When he walked he had severe pain and would hear a “popping noise.” He also had trouble walking, even with a cane. As a police officer he needed to be mobile.
He was directed by a friend to see , assistant attending orthopaedic surgeon, Hospital for Special Surgery. Dr. Della Valle suspected that the ligament that prevents the shin bone from sliding backwards, the posterior cruciate ligament , was deficient and was causing the pain and popping noises as he walked.
The diagnosis was challenging because of the partial knee replacement. To confirm his suspicions, Dr. Della Valle sent his patient for a , in the at Hospital for Special Surgery.
“The standard x-rays that had been taken in the past were masking the real problem. An x-ray cannot image soft tissue such as the PCL,” stated , Chief, Magnetic Resonance Imaging, at Hospital for Special Surgery. “The MRI Division has worked on the development of MRI protocols that allow us to capture images of the soft tissue around a total joint replacement. This technique helped us determine that the PCL was, in fact, deficient. In the past it was impossible to image soft tissue using MRI, because the metal in replacement hardware would negatively interact with the high powered imaging magnets. Our research and new techniques have helped to change that fact.”
Read the full story at huffingtonpost.com.
What Happens In An Mri
The MRI machine looks like a large hollow tube and you will lie on a table that slides into the structure. Specifically for a knee MRI, you will likely go in feet first and can generally expect the lower half of your body to be inside of the tube. It is important to anticipate the scan taking between 30 and 90 minutes depending on the types of scans and images requested by your doctor. During the MRI test itself, you will be asked to hold very still while the scan is in progress. A technician will be in an adjacent room and speaking with you through a two-way microphone to walk you through the process and answer any questions or concerns you may have during the experience.
Sometimes your doctor may request an MRI with contrast, which means you will be injected with a dye before the MRI scan. This dye will provide a greater contrast in the images produced by the MRI scan so your doctor can gain more information about the affected area. The dye may help provide more clarity to a specific area of the knee. Your doctor and the MRI technician will speak with you in detail if and when a contrast dye is part of your knee MRI.
Can Patients Whose Artificial Knee Is Comprised Of Oxinium Safely Undergo An Mri Scan Or Is There An Alternative
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Can You Have An Mri With Orthopedic Hardware
Reality: Fortunately, the majority of orthopedic devices used to care for patients can be safely scanned. This includes orthopedic joint replacements, orthopedic pins and rods and most hardware that is implanted in bone. Most patients wait 4 weeks after having an orthopedic or spinal implant before getting an MRI.6 2015 .
Feasibility Of Magnetic Resonance Imaging Monitoring Of Postoperative Total Knee Arthroplasty Without Metal Artifacts: A Preliminary Study Of A Novel Implant Model
1Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
2Trauma Center, Peking University Peoples Hospital, Beijing, China
Fortunately, with the rapid development of biomaterials science, polyetheretherketone materials with excellent mechanical properties and bioinertness, which do not demonstrate toxicity or mutagenicity, teratogenicity, and carcinogenicity, have been developed and applied clinically . PEEK is also radiologically transparent without artifact interruption on MRI scans. This preliminary study aimed to develop a novel animal model of TKA using the PEEK-on-highly cross-linked polyethylene implant and to investigate its feasibility for MRI monitoring of bone formation, the signs of infection, healing process, and local recurrence of osteosarcoma without metal artifacts, which may help improve diagnostic and therapeutic research of postoperative complications of TKA in the future.
2. Materials and Methods
2.1. Design and Fabrication of the Goat Prosthesis
Three goats were obtained from Jiagan Biotechnology Co., Ltd. . All animal studies were performed following the appropriate guidelines and in accordance with Shanghai Jiao Tong University School of Medicine Animal Care and Use Committee Guidelines.
2.3. Surgical Procedures
2.4. Postoperative Imaging
3.1. Radiographic Location of the PEEK-on-HXLPE Prosthesis
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Why Imaging Isnt Always The Answer For Knee Pain
If youve been dealing with nagging pain that seemingly originated out of nowhere, imaging may not provide the enlightenment you are looking for. Injuries that have an insidious onset, meaning came on slowly without a specific traumatic event, rarely need imaging immediately, Richardson says. This type of knee pain is often knee pain that comes onafter long distance running or biking. These are usually wear and tear injuries that will improve with rest, stretching, and leg strengthening exercises.
Richardson notes that there are some specific cases that may merit more urgent imaging for non-traumatic knee pain elderly people, very young kids, and professional athletes, for example, may need immediate attention. But for most people, strictly sticking to a self-care routine should help alleviate nagging knee pain. Dont see a difference in your symptoms? Then it may be time to seek medical care. If there is no improvement in the pain after six weeks of physical therapy, then your doctor may order imaging to see if there is anything odd going on with your knee, Richardson says.
Why Computer Imaging May Be Used Prior To Knee Replacement
Successful treatment of knee problems is aided by gathering as much information as possible about the diseased joint before forming a plan of treatment. Patients who are candidates for a knee replacement may have some form of diagnostic imaging performed as part of the process of determining the best implant for their knee. Your orthopedic surgeon has many diagnostic imaging tools available to help evaluate the extent of your disease.
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What Should I Expect From A Knee Mri
A knee MRI is a medical imaging study performed to get a look at the inside of the knee. It can be used as a diagnostic tool when a doctor suspects that there is something wrong with the knee, or it can be used as a follow up procedure to see how well a patient is healing. Knowing what to expect can make the experience more pleasant, especially for younger patients.
Knee MRIs are performed as outpatient procedures. When the patient arrives at the hospital, she or he is asked to remove all metal objects, and may be asked to get into a hospital gown. Metal objects cannot be present in the MRI room because of the magnet inside the MRI machine. Patients who have medical implants should disclose them to their doctors before getting an MRI, in case there is a risk.
Once the patient is ready, she or he is helped onto an MRI table, and pillows are used to brace the knee and hold it in place. If the hospital has an open MRI machine, it will often be used for a knee MRI for patient comfort. If the MRI machine is closed, the MRI table will slide inside the machine before it starts. During the MRI itself, the machine tends to generate very loud noises, and patients are often issued with headphones. Many hospitals provide patients with music to listen to so that they can relax.
Characteristics Of Severe Arthritis Of The Knee
Pain is the most noticeable symptom of knee arthritis. In most patients the knee pain gradually gets worse over time but sometimes has more sudden flares where the symptoms get acutely severe. The pain is almost always worsened by weight-bearing and activity. In some patients the knee pain becomes severe enough to limit even routine daily activities.
Morning stiffness is present in certain types of arthritis. Patients with morning stiffness of the knee may notice some improvement in knee flexibility over the course of the day. Rheumatoid arthritis patients may experience more frequent morning stiffness than patients with osteoarthritis.
Swelling and warmth
Patients with arthritis sometimes will notice swelling and warmth of the knee. If the swelling and warmth are excessive and are associated with severe pain, inability to bend the knee, and difficulty with weight-bearing, those signs might represent an infection. Such severe symptoms require immediate medical attention. Joint infection of the knee is discussed below.
The knee joint has three compartments that can be involved with arthritis . Most patients have both symptoms and findings on X-rays that suggest involvement of two or more of these compartments for example, pain on the lateral side and beneath the kneecap . Patients who have arthritis in two or all three compartments, and who decide to get surgery, most often will undergo total knee replacement .
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Similar Conditions That Affect The Knee
Sometimes patients with knee pain don’t have arthritis at all. Each knee has two rings of cartilage called “menisci” . The menisci work similarly to shock absorbers in a car.
Menisci may be torn acutely in a fall or as the result of other trauma or they may develop degenerative tears from wear-and-tear over many years. Patients with meniscus tears experience pain along the inside or outside of the knee. Sometimes the pain is worse with deep squatting or twisting. Popping and locking of the knee are also occasional symptoms of meniscus tears.
Since some of these symptoms may be present with arthritis and the treatment of arthritis is different from that of meniscus tears, it is important to make the correct diagnosis. A good orthopedic surgeon can distinguish the two conditions by taking a thorough history, performing a careful physical examination, and by obtaining imaging tests. X-rays and Magnetic Resonance Imaging scans may be helpful in distinguishing these two conditions.
Knee Joint Infections
Also called infectious arthritis or septic arthritis, a joint infection is a severe problem that requires emergent medical attention. If not treated promptly knee infections can cause rapid destruction of the joint. In the worst cases they can become life-threatening.Symptoms of a knee joint infection include:
- severe pain
- fevers and
Again, a joint infection is a serious condition that requires immediate medical attention.
How Will I Know If My Knee Implants Happen To Be Recalled
In the extremely unlikely event of a recalled implant, you will be contacted by the company who made the device. All implants have lot numbers registered with the implant maker. This information is kept in your medical record. If you want a copy of your X-ray or exact implant type and model for your records, please ask your physician.
Rest assured that of the millions of artificial joints implanted each year, the incidence of recall is exceedingly rare. Implant companies monitor the performance of their products very carefully.
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Possible Benefits Of Total Knee Replacement Surgery
Regardless of whether a traditional total knee replacement or a minimally-invasive partial knee replacement is performed the goals and possible benefits are the same: relief of pain and restoration of function.
The large majority of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority walk without a limp and most dont require a cane, even if they used one before the surgery. It is quite likely that you know someone with a knee replacement who walks so well that you dont know he even had surgery!
Frequently the stiffness from arthritis is also relieved by the surgery. Very often the distance one can walk will improve as well because of diminished pain and stiffness. The enjoyment of reasonable recreational activities such as golf, dancing, traveling, and swimming almost always improves following total knee replacement.
How Is The Procedure Performed
MRI exams may be done on an outpatient basis.
The technologist will position you on the moveable exam table. They may use straps and bolsters to help you stay still and maintain your position.
Small devices that contain coils that send and receive radiofrequency pulses may be placed around your knee to help improve image quality.
You will be placed into the magnet of the MRI unit. The technologist will perform the exam while working at a computer outside of the room. You will be able to talk to the technologist via an intercom.
If your exam uses a contrast material, the technologist will inject it into the intravenous line after an initial series of scans. They will take more images during or following the injection.
When the exam is complete, the technologist may ask you to wait while the radiologist checks the images in case more are needed.
The technologist will remove your IV line after the exam is over and place a small dressing over the insertion site.
The entire exam is usually completed in 45 minutes.
See the Conventional Arthrography page for more information.
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How Does Knee Pain Affect Lifestyle
How pain is perceived and tolerated is unique to each individual. If knee pain affects working, socializing, sleeping, maintaining good hygiene, or other daily activities, then it may be time to consider knee replacement surgery.
Knee pain and active lifestylesPeople who live active lives may be more affected by knee pain and decide to have knee replacement surgery sooner. For example, a person whose regular activities include standing for work, babysitting grandchildren, and walking a pet dog may be more affected by arthritic knee pain than a person who lives a more sedentary life.
Pain and joint damage do not always match upThe decision to have knee replacement surgery should not be based solely on medical imaging that shows severe knee degeneration. Rather, it should be based on moderate to severe knee arthritis symptoms that correlate with medical imaging.
For example, a person whose x-ray shows a severely degenerated knee but who experiences only mild pain is probably not a good candidate for knee replacement. In contrast, a person who has a moderately degenerated knee and experiences severe pain may be a good candidate for knee replacement.
When You Can Expect To Wait
There are a few stops on the journey to getting surgery. We track wait times at two key points.
Your family doctor refers you to a specialist.
The number of days between your specialist getting the referral from your family doctor and your first appointment with the specialist.
You meet with the specialist.
The time it takes for you to get any tests , if necessary, or have further consultation with the specialist before they decide if you need surgery.
Because everyones situation is so unique, we can’t track this wait period.
You and your specialist decide to go ahead with surgery.
The number of days from when you and your specialist you will have surgery to actually having the surgery.
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Dont Give Up After One No
If you need an MRI but get turned down by an imaging center or hospital, dont give up. Not every imaging facility does the extensive training we do at RAYUS to teach our team how to customize scans for implant patients. We build protocols to meet the criteria of the device and still get you and your doctor high-quality images. Dont assume youre not eligible for an MRI based on one no or even more than one.
With her shoulders full of metal, Sylvia was turned down more than once, but she kept looking for an alternative. As she left RAYUS with her shoulder images in hand, she said, Im looking forward to what the radiologist, the doctor will diagnose from this MRI. I just want to find out, validate the pain that Im in, and to see if theres any corrective issues or even surgery.
So, dont give up on imaging with an implant. You can get the answers you need.
Is There A Long
No, the implants are engineered to withstand your body weight and activity level, but the moving parts of a knee replacement do wear over a period of several decades. A properly aligned knee replacement done by a competent, experienced surgeon will usually last the lifetime of most patients.
Subtle component malpositioning and suboptimal orientation can however compromise the lifespan of the implant. This is why the skill and expertise with which the knee is implanted in your body is a critical determinant of how long the knee will last and how well it will perform.
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