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Hip: Arthroplasty Complication

Clinical: 73 y/o patient with chronic right hip pain after hip arthroplasty

Dx: MRI findings of soft tissue complication of right total hip arthroplasty; metal-on-metal disease and/or aseptic lymphocytic vasculitis associated lesion (ALVAL).  These include a large amount of intra-articular synovitis/debris distending the pseudocapsule and two focal areas of capsular dehiscence with extra-articular extension of synovitis/debris.  There are small areas of osteolysis associated with the intra-articular synovitis; located at the superior margins of the femoral component near the greater trochanter and the lateral margins of the acetabular component.  The posteroinferior periarticular synovitis does come in close proximity to the sciatic nerve and the sciatic nerve may be slightly posteriorly displaced in this region.  No sciatic nerve signal abnormality.

Note:  MRI is the modality of choice after x-ray for assessment of the painful hip prosthesis.