Ultrasound and MRI are the primary imaging techniques used to detect pseudotumors and other soft tissue pathology in patients with metal-on-metal THAs. Soft tissue lesions can be difficult to detect because patients can have symptoms, such as pain and discomfort and elevated cobalt and chromium levels, or no symptoms at all. There have been several studies comparing the efficacy of the relatively low cost ultrasound, done with a variety of portable ultrasound machines and more high-end fixed devices, with the higher cost MRI but none have compared ultrasound to actual revision surgery findings. The authors of this article described the prevalence and type of pseudotumors detected with pre-revision ultrasound and compared it to revision surgery findings. They concluded that the presence of pseudotumors is well detected with ultrasound but there is a discrepancy with intraoperative findings at revision.

See Lainiala, O. et al. Good sensitivity and specificity of ultrasound for detecting pseudotumors in 83 failed metal-on-metal hip replacements, Acta Orthopaedica, 86, Epub, (2015)

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