Abstract
We present our case report using a novel metal artefact reduction magnetic resonance imaging (MRI) sequence to observe resolution of subchondral bone marrow lesions (BMLs), which are strongly associated with pain, in a patient after total knee replacement surgery. Large BMLs were seen preoperatively on the 3-Tesla MRI scans in a patient with severe end stage OA awaiting total knee replacement surgery. Twelve months after surgery, using a novel metal artefact reduction MRI sequence, we were able to visualize the bone-prosthesis interface and found complete resection and resolution of these BMLs. This is the first reported study in the UK to use this metal artefact reduction MRI sequence at 3-Tesla showing that resection and resolution of BMLs in this patient were associated with an improvement of pain and function after total knee replacement surgery. In this case it was associated with a clinically significant improvement of pain and function after surgery. Failure to eradicate these lesions may be a cause of persistent postoperative pain that is seen in up to 20% of patients following TKR surgery.
Highlights
Painful osteoarthritis (OA) is the 4th largest cause of ill health and disability in the United Kingdom [1]
We report our early finding using a novel metal artefact reduction magnetic resonance imaging (MRI) sequence showing the complete resection and resolution of bone marrow lesions (BMLs) 12 months after Total knee replacement surgery (TKR) surgery with an associated improvement of pain and function of the knee
This is the first reported use of the novel MAVRIC MRI sequence at 3-Tesla used in the UK after TKR surgery to report the relationship between resolving pain and the disappearance of BMLs
Summary
Painful osteoarthritis (OA) is the 4th largest cause of ill health and disability in the United Kingdom [1]. 75% of patients with painful osteoarthritis of the knee have subchondral BMLs on MRI, and several large studies have reported the correlation of subchondral BMLs with pain [3]. Total knee replacement surgery (TKR) is one of the most common orthopaedics procedures performed worldwide and is generally a very successful and cost-effective treatment for improving pain and function in patients with severe painful OA. TKR is an effective surgical intervention; up to 20% of all patients who undergo this surgery report severe dissatisfaction and chronic postoperative pain in spite of objective measures of surgical success [5]. We report our early finding using a novel metal artefact reduction MRI sequence showing the complete resection and resolution of BMLs 12 months after TKR surgery with an associated improvement of pain and function of the knee
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