The Management of the Symptomatic Patient With a Metal-on-Metal Hip Prosthesis Kate Harrington, MB, BCh, BAO, MRCPI, Emma Phelan, MB, BCh, NUI, MRCPI,

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The Management of the Symptomatic Patient With a Metal-on-Metal Hip Prosthesis Kate Harrington, MB, BCh, BAO, MRCPI, Emma Phelan, MB, BCh, NUI, MRCPI, William C. Torreggiani, MB, MRCPI, FRCR, FFRRCSI, Orla Doody, MB, MRCPI, FFRRCSI Canadian Association of Radiologists Journal Volume 67, Issue 1, Pages 76-81 (February 2016) DOI: 10.1016/j.carj.2015.10.006 Copyright © 2016 Canadian Association of Radiologists Terms and Conditions

Figure 1 Initial (A) and subsequent (B) follow up radiograph demonstrated new lucency (circle) at the medial aspect of the femoral component of the right prosthesis. Canadian Association of Radiologists Journal 2016 67, 76-81DOI: (10.1016/j.carj.2015.10.006) Copyright © 2016 Canadian Association of Radiologists Terms and Conditions

Figure 2 Coronal and axial T1 weighted (A, B) and STIR weighted (C, D) images demonstrate large joint effusions extending into the iliopsoas bursae bilaterally and extending into the trochanteric bursa. These collections communicate with the hip joints bilaterally (asterisk) and demonstrate multiple foci of internal debris (arrows). The periprosthetic collections have a marked low signal rim (dashed arrows) and an irregular capsule. Canadian Association of Radiologists Journal 2016 67, 76-81DOI: (10.1016/j.carj.2015.10.006) Copyright © 2016 Canadian Association of Radiologists Terms and Conditions

Figure 3 Axial and coronal T2-weighted fast spin echo (A, B), coronal T1-weighted images (C) demonstrate a large left iliopsoas bursa (arrows) communicating with the anterior hip joint with multiple foci of low signal and debris. A similar but smaller right iliopsoas bursa is also present with foci of low signal and internal debris (dashed arrow). Canadian Association of Radiologists Journal 2016 67, 76-81DOI: (10.1016/j.carj.2015.10.006) Copyright © 2016 Canadian Association of Radiologists Terms and Conditions

Figure 4 Coronal T2-weighted fast spin-echo (A) and coronal T1-weighted images (B) demonstrate bilateral joint effusions, larger on the left, which demonstrate multiple foci of internal debris. The effusions have a marked low signal rim and an irregular capsule. Canadian Association of Radiologists Journal 2016 67, 76-81DOI: (10.1016/j.carj.2015.10.006) Copyright © 2016 Canadian Association of Radiologists Terms and Conditions

Figure 5 Ultrasound images demonstrating a thick walled, cystic lesion in close proximity to the right hip joint. Internal iso- and hyperechoic debris is demonstrated lying within the lesion. It is often difficult to determine if this lesion is in continuity with the hip joint on ultrasound and cross-sectional imaging is usually then undertaken to further characterise the abnormality. Canadian Association of Radiologists Journal 2016 67, 76-81DOI: (10.1016/j.carj.2015.10.006) Copyright © 2016 Canadian Association of Radiologists Terms and Conditions