Hollis G Potter

Hospital for Special Surgery, New York, New York, United States

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Publications (252)621.88 Total impact

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    ABSTRACT: Background: Recent total hip arthroplasty designs have introduced modularity at the neck-stem junction. There are reports of failure of this class of designs due to corrosion at the modular junction. The purpose of this study was to evaluate patients implanted with a recently recalled modular total hip arthroplasty system. Methods: This was a prospective study of 216 total hip arthroplasties in 195 patients performed by a single surgeon. All hips had a titanium-alloy stem, but 199 had a modular cobalt-chromium neck and seventeen were monolithic. The mean patient age was 65.4 years (range, twenty to eighty-eight years); seventy-nine were men and 116 were women. Patients were evaluated for infection and with metal ion assays and MRI (magnetic resonance imaging). Intraoperative tissue samples were graded, and retrieved implants were examined. Results: At a mean follow-up of 19.3 months, eighty (37%) of 216 hips had been revised. An adverse local tissue reaction (ALTR) was the cause for revision in seventy-three of these eighty hips; all had the modular neck design. Assay results for the patients requiring revision showed higher levels of cobalt (mean, 8.6 ng/mL) than chromium (mean, 1.8 ng/mL). MRI showed moderate to severe levels of synovial response in sixty-three of 166 hips. The mean ALVAL (aseptic lymphocytedominated vasculitis-associated lesion) score for the revised hips was 8.1. Corrosion was visible on all tapers at the neck-stem junction but not the head-neck junction. Conclusions: Early failures of modular total hip arthroplasty occur due to fretting and corrosion at the neck-stem junction, resulting in ALTR. Surveillance utilizing metal ion levels and MRI may be indicated for all patients regardless of symptoms, as the early survivorship is poor and the ultimate failure rate may be catastrophically high.
    No preview · Article · Jan 2016 · The Journal of Bone and Joint Surgery
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    ABSTRACT: Femoroacetabular impingement (FAI) refers to a condition characterized by impingement of the femoral head–neck junction against the acetabular rim, often due to underlying osseous and/or soft tissue morphological abnormalities. It is a common cause of hip pain and limited range of motion in young and middle-aged adults. Hip preservation surgery aims to correct the morphological variants seen in FAI, thereby relieving pain and improving function, and potentially preventing early osteoarthritis. The purpose of this article is to review the mechanisms of chondral and labral injury in FAI to facilitate an understanding of patterns of chondrolabral injury seen on MRI. Preoperative MRI evaluation of FAI should include assessment of osseous morphologic abnormalities, labral tears, cartilage status, and other associated compensatory injuries of the pelvis. As advanced chondral wear is the major relative contraindication for hip preservation surgery, MRI is useful in the selection of patients likely to benefit from surgery. Teaching points • The most common anatomical osseous abnormalities predisposing to FAI include cam and pincer lesions. • Morphological abnormalities, labral lesions, and cartilage status should be assessed. • In cam impingement, chondral wear most commonly occurs anterosuperiorly. • Pre-existing advanced osteoarthritis is the strongest predictor of poor outcomes after FAI surgery. • Injury to muscles and tendons or other pelvic structures can coexist with FAI.
    No preview · Article · Dec 2015 · Insights into Imaging
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    ABSTRACT: Background: Limited information exists on the clinical use of a synthetic osteochondral scaffold plug for cartilage restoration in the knee. Purpose/hypothesis: The purpose of this study was to compare the early magnetic resonance imaging (MRI) appearance, including quantitative T2 values, between cartilage defects treated with a scaffold versus a scaffold with platelet-rich plasma (PRP) or bone marrow aspirate concentrate (BMAC). The hypothesis was that the addition of PRP or BMAC would result in an improved cartilage appearance. Study design: Cohort study; Level of evidence, 3. Methods: Forty-six patients with full-thickness cartilage defects of the femur were surgically treated with a control scaffold (n = 11), scaffold with PRP (n = 23), or scaffold with BMAC (n = 12) and were followed prospectively. Patients underwent MRI with a qualitative assessment and quantitative T2 mapping at 12 months after surgery. An image assessment was performed retrospectively by a blinded musculoskeletal radiologist. The cartilage phase was measured by cartilage fill and quantitative T2 values on MRI. A comparison between groups after cartilage repair was performed. Results: The control scaffold group consisted of 8 male and 3 female patients (mean age, 38 years; mean body mass index [BMI], 25 kg/m(2)), the PRP group had 15 male and 8 female patients (mean age, 39 years; mean BMI, 26 kg/m(2)), and the BMAC group consisted of 8 male and 4 female patients (mean age, 36 years; mean BMI, 26 kg/m(2)). The PRP-treated (P = .002) and BMAC-treated (P = .03) scaffolds had superior cartilage fill compared with the control group. With quantitative methods, the PRP group demonstrated a mean T2 value (49.1 ms) that was similar to that of the control scaffold group (42.7 ms; P = .07), but the BMAC group demonstrated a mean T2 value (60.5 ms) closer to that of superficial hyaline cartilage (P = .01). The stratification of T2 values between the deep and superficial zones was not observed in any of the groups. Conclusion: In this comparative study, patients treated with scaffold implantation augmented with BMAC had improved cartilage maturation with greater fill and mean T2 values closer to that of superficial native hyaline cartilage at 12 months. Further work will determine if this translates into improved clinical outcomes.
    No preview · Article · Nov 2015 · The American Journal of Sports Medicine

  • No preview · Article · Oct 2015
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    ABSTRACT: Background Evaluating postoperative femoral neck facture (FNF) with metal fixation hardware is commonly performed using radiographs. MRI has greater sensitivity and specificity to evaluate osteonecrosis (ON) but is often challenging due to the image distortion caused by metallic hardware. Questions/Purposes The aim of this study is to compare fast spin-echo (FSE) and multi-acquisition variable-resonance image combination (MAVRIC) sequences in assessing ON following metallic fixation of FNF and determining feasibility of semi-quantitative perfusion using MAVRIC. Methods Radiography and MRI were performed at 3 and 12 months postoperatively, using FSE and pre- and post-gadolinium contrast MAVRIC sequences in 21 FNF patients. The presence and volume of ON were recorded. Signal intensity (SI) enhancement was measured on the MAVRIC sequences within the center and rim of ON; with the ilium and femoral diaphysis as controls. The detection rate of ON between MAVRIC and FSE images was evaluated as the difference of percent enhancement across the defined regions of interest. Results ON was detected in 0% of radiographs, in 67% of FSE, and in 76% of MAVRIC images at 3 months follow-up, with similar results at 12 months. MAVRIC images had larger ON volume than FSE images at both time points. A significant percentage SI enhancement was only detected in the ON rim. Conclusion Radiographs could not detect ON following metallic fixation of FNF. MAVRIC is more sensitive than FSE for determining the volume of ON. SI measurements using MAVRIC may provide an indirect assessment of perfusion.
    No preview · Article · Oct 2015 · HSS Journal
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    ABSTRACT: Background: Lesions associated with posterior humeral avulsion of the glenohumeral ligament (HAGL) can lead to persistent symptoms related to posterior shoulder instability and can be commonly missed or delayed in diagnosis. Purpose: To identify and characterize the MRI findings in patients with a posterior HAGL lesion. Study design: Case series; Level of evidence, 4. Methods: This retrospective case series included 27 patients (28 shoulders) identified by search through the senior authors' databases, with cross-reference to their institutional radiologic communication system for MRI review. Baseline patient demographic data were collected, including age and sex. All posterior HAGL lesions were identified on MRI and characterized as partial, complete, or floating lesions. All acute glenohumeral pathologic changes concurrent with the posterior HAGL were documented. Chondrolabral retroversion of the injured shoulder was measured on axial MRI. Results: The average age of the identified cohort was 33.6 years (range, 15-81 years), and 23 patients were male (86%). Posterior HAGL injuries were found to be complete tears (71%), partial tears (25%), and floating lesions (4%); concomitant bony HAGL avulsion was found in 7% of injuries. Additional traumatic glenohumeral disorders occurred in 93% of cases. The most common concurrent injuries were reverse Hill-Sachs lesions (36%), anterior Bankart lesions (29%), and posterosuperior rotator cuff tears (25%). Notably, concomitant anterior labral or capsular injury was found in 50% of patients, signifying bidirectional disruption of the capsule. In addition, increased chondrolabral version was found in this cohort (10.2° ± 3.7° retroversion). Conclusion: This study depicts the high association of combined injury with posterior HAGL lesions and increased chondrolabral retroversion. Findings on MRI related to a posterior HAGL injury could potentially be masked by additional injury and may occur with mechanisms that also lead to anterior glenohumeral disorders.
    Full-text · Article · Oct 2015 · The American Journal of Sports Medicine
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    ABSTRACT: The purpose of this study was to evaluate whether patients with bilateral metal-on-metal (MoM) hip replacements have symmetric adverse local tissue reactions (ALTRs) at follow-up. An MRI of both hips was performed at a mean time of six years after surgery in 43 patients. The prevalence and severity of ALTRs were found to be similar in simultaneous hips but differences were observed in sequential hips. The order and timing of sequential hip arthroplasties did not affect the severity of ALTRs. Thus, in addition to metal ion exposure from an earlier MoM implant other factors may also play a role in the progression of ALTRs. Bilateral implants should be given special consideration in risk stratification algorithms for management of patients with MoM hip arthroplasty.
    Full-text · Article · Oct 2015 · The Journal of Arthroplasty

  • No preview · Article · Sep 2015 · Journal of Orthopaedic Trauma
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    ABSTRACT: Advances in current clinical modalities, including magnetic resonance imaging and computed tomography, allow for earlier diagnoses of cartilage damage that could mitigate progression to osteoarthritis. However, current imaging modalities do not detect submicrometer damage. Developments in in vivo or arthroscopic techniques, including optical coherence tomography, ultrasonography, bioelectricity including streaming potential measurement, noninvasive electroarthrography, and multiphoton microscopy can detect damage at an earlier time point, but they are limited by a lack of penetration and the ability to assess an entire joint. This article reviews current advancements in clinical and developing modalities that can aid in the early diagnosis of cartilage injury and facilitate studies of interventional therapeutics.
    No preview · Article · Aug 2015 · Cartilage
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    ABSTRACT: Adverse local tissue reactions (ALTRs) around hip arthroplasties are an important reason for failure of metal-on-metal (MoM) hip implants. Little is known about capsular dehiscence patterns as ALTRs decompress from the hip into the surrounding tissue planes; these patterns may also influence the onset and severity of patient symptoms. Through a multicenter study approach, we asked: (1) Is ALTR location related to the surgical approach used for arthroplasty in patients who underwent hip arthroplasty (resurfacing or THA) with a single, recalled hip arthroplasty system? (2) Do ALTR severity and location affect patient-reported outcomes in these patients? (3) Is ALTR severity different between patients who received the resurfacing version of this component (Articular Surface Replacement [ASR]) and those who received the THA implant in this system (ASR XL)? In a multicenter prospective study of patients who had undergone surgery with use of the ASR and ASR XL hip system (DePuy Orthopaedics, Warsaw, IN, USA), 288 patients (333 hips) from two centers had a metal artifact reduction sequence MRI of the hip performed at a mean time of 6 years postsurgery. Procedures included 166 hips (50%) with ASR resurfacing and 167 hips (50%) with ASR XL THA performed between 2004 and 2010. One hundred twenty-nine hips (39%) had been operated on using a direct lateral approach and 204 using a posterior approach (61%). The EQ-5D, Harris hip score, UCLA activity score, and visual analog scale pain score were obtained for each patient. ALTRs were classified using the Anderson ALTR grading system, and the location, synovial thickness, and diameter of the ATLRs were assessed. The relationship between ALTR location and surgical approach as well as for ALTR severity and patient-reported outcomes were evaluated, and logistic regression was used to identify predictors for moderate-to-severe ALTRs. Moderate or severe ALTRs were identified in 79 hips (24%); 41 of these hips had been operated on using the direct lateral approach and 38 using the posterior approach. In patients in whom the lateral approach was used, 83% had an anterior ALTR. Similarly, 71% of patients in the posterior approach group had posterior ALTRs. There were no differences in patient-reported outcome measures between patients with moderate-to-severe ALTRs and those with no ALTR findings on MRI (p > 0.09). Use of ASR XL was an independent risk factor for moderate-to-severe ALTRs (odds ratio, 2.8; 95% confidence interval, 1.4-5.5 p = 0.004) and patients with ASR XL also had a thicker synovium (median ASR XL = 3.6 mm [1.2-10.6 mm], median ASR = 2.6 mm [1.2-10.7 mm], p < 0.001) and larger maximal ALTR diameter (median ASR XL = 47.6 mm [14-109.70 mm], median ASR = 38.4 [17.2-118.0 mm], p = 0.02) than patients treated with ASR. The location of ALTRs can be predicted based on the previous surgical approach to the hip. Patients with ASR XL are more likely to develop moderate-to-severe ALTRs compared with ASR patients. An extensive range of patient-reported outcome measures may not identify all patients with ALTRs further supporting the use of MRI as a screening measure for ALTRs. Level II, therapeutic study.
    Full-text · Article · Aug 2015 · Clinical Orthopaedics and Related Research
  • Jan Fritz · Brett Lurie · Hollis G. Potter
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    ABSTRACT: PURPOSE/AIM Discuss optimization strategies for MRI of knee arthroplasty and the utility of dedicated metal artifact reduction pulse sequences Review the normal MRI appearances of knee arthroplasty Systematically illustrate the MRI diagnoses of arthroplasty-associated complications CONTENT ORGANIZATION The role of MRI following knee arthroplasty Optimized MR imaging protocol, MR angiography and dedicated metal artifact reduction pulse sequences Normal MRI appearances and MRI diagnosis of complications: Fibrous membrane formation, bone resorption and aseptic loosening Polyethylene wear-induced synovitis and osteolysis Infection, non-specific synovitis and arthrofibrosis Impingement syndromes and patellar clunk Recurrent hemarthrosis – MR angiography assessment Stress reactions and fractures Component rotational alignment Polyethylene displacement Instability and excessive soft tissue balancing Musculotendinous abnormalities Neurovascular compromise SUMMARY Optimized and dedicated MRI techniques reduce metal artifacts and improve our ability to assess and differentiated knee arthroplasty-associated complications. MRI is accurate for the diagnosis of bone resorption, synovitis, malalignment and hemarthrosis and can detect infection, muscle, tendon and nerve abnormalities.
    No preview · Conference Paper · Aug 2015
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    ABSTRACT: It has been suggested that the extent and location of cartilage deformation within a joint under compressive loading may be predictive of predisposition to further degeneration. To explore this relationship in detail requires the quantification of cartilage deformation under controlled loads on a per-patient basis in a longitudinal manner. Our objectives were (1) to design a device capable of applying controllable axial loads while ensuring repeatable within-patient tibiofemoral positioning during magnetic resonance imaging (MRI) scans and (2) to determine the duration for which load should be maintained prior to the image acquisition, for a reproducible measurement of cartilage deformation, within the restraints of a clinical setting. A displacement control loading device was manufactured from MRI-compatible materials and tested on four volunteers for the following five scans: an unloaded scan, two repeat immediate scans which were started immediately after the application of 50% body weight, and two repeat delayed scans started 12min after load application. Outcome measures included within-patient changes in tibiofemoral position and cartilage deformation between repeat loaded scans. The differences in tibiofemoral position between repeat loaded scans were <1mm in translation and <2° in rotation. Cartilage deformations were more consistent in the delayed scans compared to the immediate scans. We conclude that our loading device can ensure repeatable tibiofemoral positioning to allow for longitudinal studies, and the delayed scan may enable us to obtain more reproducible measurements of cartilage deformation in a clinical setting. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Aug 2015 · Journal of Biomechanics
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    ABSTRACT: Background: Osteochondral autografts and allografts have been widely used in the treatment of isolated Grade IV articular cartilage lesions of the knee. However, there is paucity in the literature with regards to the basic science investigating the direct comparison between fresh osteochondral allografts to autografts. Hypothesis: At twelve months, fresh osteochondral allografts are equal to autografts with respect to function, bony incorporation into host bone and chondrocyte viability. Study Design: Prospective comparative in-vivo animal model study Methods: Eight adult mongrel dogs underwent bilateral hind limb osteochondral graft implantation in the knee after creation of an Outerbridge Grade IV cartilage defect. One hind limb knee received an autograft, and the contralateral knee received an allograft. All dogs were sacrificed at twelve months. Graft analysis included gross examination, radiographs, magnetic resonance imaging, biomechanical testing and histology. Results: Magnetic resonance imaging demonstrated excellent bony incorporation of both autografts and allografts, except one allograft, which revealed partial incorporation. Histologic examination of cartilage showed intact hyaline appearance for both autografts and allografts, with fibrocartilage at the interface of both. Biomechanical testing demonstrated no significant difference between allografts and autografts (p=0.76). Furthermore, no significant difference was observed between allografts and the native cartilage with biomechanical testing (p=0.84). Conclusions: After 12 months from time of implantation, fresh osteochondral allograft and autograft tissue are not statistically different with respect to biomechanical properties, bony incorporation and chondrocyte viability.
    No preview · Conference Paper · Aug 2015
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    ABSTRACT: Magnetic resonance imaging (MRI) visualization of meniscal signal is particularly challenging as the highly organized ultrastructure of meniscal fibrocartilage yields very short T2 values (∼6 ms) and a paucity of signal intensity during conventional image acquisition. The purpose of this study was to evaluate the feasibility of imaging postoperative menisci using an experimental, quantitative ultrashort echo time (UTE) MRI pulse sequence. This sequence acquires short echo images (echo time (TE) ∼0.3 ms) to produce multi-echo images for quantitative T2* calculations that provide an objective measure of collagen organization. MRI scans of the knee were acquired at 6- and 12-month intervals on a clinical 3.0 T scanner following meniscal surgery in eight patients (ages 13-41), four of whom underwent repair and the other four partial meniscectomy. Conventional MRI sequences were qualitatively evaluated for meniscal morphology and signal and correlated with quantitative UTE results. A wide range of mean T2* values for both postsurgical groups was measured, and these values changed for each patient between the 6- and 12-month intervals. In many instances, the UTE sequence demonstrated quantitative differences between the two time intervals that were not detected with conventional sequences. This pilot study presents preliminary, observational data to be used as a baseline for future studies. Although the T2* values did not reveal a trend in either group or correlate with expected signal changes on conventional MRI, we speculate that the UTE sequence may detect ultrastructural alterations in meniscal composition that are otherwise not perceived with routine fast spin echo (FSE) sequences.
    No preview · Article · Jul 2015 · HSS Journal
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    ABSTRACT: The enhanced posterior soft tissue repair has reduced the frequency of dislocation after primary THA performed through the posterolateral approach. However, the long-term integrity of the repair is unknown and could influence surgeon choice regarding surgical technique and THA approach. We asked: (1) What is the durability of the enhanced posterior soft tissue repair at a minimum of 49 months using MRI to evaluate soft tissue to bone integrity? (2) How does the appearance of the posterior soft tissues change during this time? (3) Are there patient characteristics associated with the long-term imaging appearance of the posterior repair? All patients without a contraindication for MRI who were undergoing unilateral primary uncemented THA through a posterior approach between February and May 2005 were eligible for inclusion. Ninety percent consented to participate (36 of 40 patients), and 30 patients were followed prospectively with MRI postoperatively and again at 3 months; of those, 22 (73%; 12 men, 10 women) completed the study by having another MRI study at a minimum of 49 months (mean, 51 months; range, 49-59 months). Each patient underwent metal-artifact-reduction sequence MRI to evaluate the integrity of the posterior soft tissues, which had been repaired anatomically during primary THA at a minimum of 4 years earlier. The results were compared with those of prior MR images obtained immediately after surgery and at 3 months postoperatively. All patients were given a self-reported modified Harris hip score at the time of the most recent MRI study (maximum score = 81). At latest followup, 21 of 22 (96%) patients had a posterior capsule in contact with bone, and 21 of 22 (96%) had an intact quadratus femoris. Twenty-one patients (96%) had soft tissue or a scar from the piriformis and conjoined tendons in continuity with bone. In these cases, the interface between the piriformis and conjoined tendons and the greater trochanter observed immediately postoperatively and at 3 months postoperatively became filled with hypointense tissue, with signal characteristics similar to tendon. Time from surgery was most associated with changes in native tendon-to-bone distances (p < 0.001) and MRI signal intensity of the repair (p < 0.001). At followup of just more than 4 years, the posterior capsule and quadratus femoris most often were healed to bone. In the majority of patients, scar tissue between the piriformis and conjoined tendons and bone matured to achieve orientation and signal intensity resembling native tendon. We believe the enhanced posterior soft tissue repair facilitates this process. Our results provide a plausible explanation for improved postoperative stability observed in patients receiving an enhanced soft tissue repair compared with those in whom a repair is not performed. Level IV, therapeutic study.
    No preview · Article · Jun 2015 · Clinical Orthopaedics and Related Research
  • Sarah L Pownder · Parina H Shah · Hollis G Potter · Matthew F Koff
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    ABSTRACT: Analysis of fresh specimens in research studies is ideal; however, it is often necessary to freeze samples for evaluation at a later time. Limited evaluation of the effect of freeze-thawing of tendon tissue samples on inherent magnetic resonance imaging (MRI) parameters, such as ultrashort echo time (UTE) T2* values, have been performed to date. This study performed UTE MRI on 14 bovine patellar tendons at harvest and after four consecutive freeze-thaw cycles. Results demonstrated a small but significant reduction (12%) in tendon T2* values after the first freeze thaw cycle, but not after successive cycles. Tendons from juvenile animals with open physis had a significant reduction of T2* following a single freeze thaw cycle, P<0.0001. The results of this study emphasize the importance of using uniform tendon storage protocols when using UTE MRI in preclinical models.
    No preview · Article · Jun 2015
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    ABSTRACT: Purpose To describe the magnetic resonance (MR) imaging characteristics associated with adverse local tissue reactions and tissue damage around hip arthroplasties in which the recalled Rejuvenate modular dual-taper stem was used. Materials and Methods The institutional review board of the Hospital for Special Surgery approved the study. All study patients provided informed consent. MR imaging studies were retrospectively reviewed in a cohort of 58 patients with 66 hip arthroplasties with Rejuvenate stems who had presented for imaging evaluation because of recall of the implant. Multiple regression analysis was used to examine MR imaging features, biomechanical factors, and metal ion levels as predictors of aseptic lymphocytic vasculitis-associated lesion (ALVAL) score at histologic assessment while adjusting for age and sex for 54 revised hips. Results Revision surgery was performed in 54 hips on the basis of clinical or imaging findings (24% of hips were completely asymptomatic). The median ALVAL score among the revised hips was 9 (range, 1-10). Imaging characteristics observed with high frequency in patients with ALVAL included synovitis, mixed- or solid-type synovitis, synovial thickening, and capsular dehiscence. Conclusion MR imaging provides an effective noninvasive method for assessing the presence and severity of adverse local tissue reaction, as well as the degree of pre-existing tissue damage, thereby facilitating early and accurate identification of candidates for revision surgery. (©) RSNA, 2015.
    No preview · Article · Jun 2015 · Radiology
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    ABSTRACT: The purpose of this study was to evaluate whether patients with bilateral metal-on-metal (MoM) hip replacements have symmetric adverse local tissue reactions (ALTRs) at follow-up. An MRI of both hips was performed at a mean time of six years after surgery in 43 patients. The prevalence and severity of ALTRs were found to be similar in simultaneous hips but differences were observed in sequential hips. The order and timing of sequential hip arthroplasties did not affect the severity of ALTRs. Thus, in addition to metal ion exposure from an earlier MoM implant other factors may also play a role in the progression of ALTRs. Bilateral implants should be given special consideration in risk stratification algorithms for management of patients with MoM hip arthroplasty. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · May 2015 · The Journal of arthroplasty
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    ABSTRACT: Imaging of hip in osteoarthritis (OA) has seen considerable progress in the past decade, with the introduction of new techniques that may be more sensitive to structural disease changes. The purpose of this expert opinion, consensus driven recommendation is to provide detail on how to apply hip imaging in disease modifying clinical trials. It includes information on acquisition methods/techniques (including guidance on positioning for radiography, sequence/protocol recommendations/hardware for magnetic resonance imaging (MRI)); commonly encountered problems (including positioning, hardware and coil failures, artifacts associated with various MRI sequences); quality assurance/control procedures; measurement methods; measurement performance (reliability, responsiveness, and validity); recommendations for trials; and research recommendations. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
    Full-text · Article · May 2015 · Osteoarthritis and Cartilage
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    ABSTRACT: Objectives: Sisterman described the “Biceps Footprint”, Castagna et al reported on “Chondral Imprints,” and Kuhn et al identified “Humeral Head Abrasions.”[1],[2],[3] These can be considered types of biceps chondromalacia (BCM), as we define it, which is an attritional lesion on the humeral head, caused by abrasion of the LHBT over time. BCM occurs in two distinct types: “Junctional” or “Medial”. Junctional BCM (Figure 1) is found along the articular margin of the humeral head where the biceps tendon exits the joint. Medial BCM (Figure 2) is found on the anteromedial portion of the articular surface and may result from chronic “incarceration” of the LHBT between the humeral head and glenoid, a dynamic lesion elicited by the arthroscopic active compression test.[4] The pre-operative assessment of BCM has never been addressed. The purpose of the study was to evaluate the ability of pre-operative MRI to diagnose BCM.
    Preview · Article · Apr 2015 · Journal of Shoulder and Elbow Surgery

Publication Stats

7k Citations
621.88 Total Impact Points


  • 1994-2016
    • Hospital for Special Surgery
      • Department of Orthopaedic Surgery
      New York, New York, United States
  • 1996-2015
    • Cornell University
      • Department of Orthopaedic Surgery
      Итак, New York, United States
  • 2014
    • Rush University Medical Center
      Chicago, Illinois, United States
  • 2000-2014
    • Weill Cornell Medical College
      • • Department of Radiology
      • • Department of Orthopaedic Surgery
      New York City, New York, United States
  • 2011
    • University of Eastern Finland
      • Department of Physics and Mathematics
      Kuopio, Eastern Finland Province, Finland
  • 2010
    • Brown University
      Providence, Rhode Island, United States
  • 2004
    • University of Colorado at Boulder
      Boulder, Colorado, United States
  • 1995
    • Drexel University
      • Department of Chemical and Biological Engineering
      Filadelfia, Pennsylvania, United States