Is it possible to do an MRI for hip replacement? After joint replacement. Titanium rod - is it possible to do magnetic resonance imaging?

It is a common belief that people with implants should not have an MRI. In fact, this was the case several decades ago, when patients were fitted with prosthetics made of steel, nickel and cobalt. In those years, magnetic resonance imaging could cause serious harm to human health.

TBS implant.

Let's be clear from the beginning that people with implants, pins, screws, retaining plates, breast implants, and dental implants CAN have an MRI.

What implants can be used for MRI?

MRI is allowed for people who have undergone hip or knee replacement. It is important that the endoprosthesis or fixation for osteosynthesis is made of metals or ceramics with low magnetic susceptibility. This avoids displacement or overheating of the structure during the examination.

Knee endoprosthesis.

People with hernia mesh, dental, breast and joint replacements are also allowed to have an MRI. All these implants are made from materials that do not interact with magnetic field. This makes the study safe. However, you should consult a specialist before an MRI. The doctor will evaluate possible risks and recommend the necessary precautions.

Interaction of different metals with a magnetic field

Different metals tend to interact with magnets differently. Some of them are attracted to it, others are repelled, and others do not react at all. All three types of metals are used for the manufacture of endoprostheses.

Table 1. Metal classes.

Class	Representatives	Description
Diamagnets	Copper Zirconium Silver Zinc	They have negative magnetic susceptibility. This means that when interacting with a magnetic field, they repel rather than attract.
Paramagnets	Titanium Tungsten Aluminum Tantalum Chrome Molybdenum	These metals are characterized by the presence of low magnetic susceptibility, independent of the magnetic field strength. Paramagnetic prostheses usually tolerate the MRI procedure well and do not move or heat up.
Ferromagnets	Iron Nickel Cobalt Steel	They have high magnetic susceptibility, depending on the magnetic field strength. Implants containing a large number of These metals may become dislodged or heated during an MRI.

Composition of modern endoprostheses

All plates, pins and endoprostheses, which are used in modern traumatology and orthopedics, consist of a variety of alloys. Note that different implants contain different amounts of paramagnetic and ferromagnetic materials. The properties of each endoprosthesis, pin or plate depend on the composition.

Not all prostheses are 100% metal. Most of them contain ceramics or polyethylene. The latter does not interact with the magnetic field, therefore, it does not in any way affect the MRI results and the course of the procedure. However, ceramics most often contain aluminum oxide, which still has a certain magnetic susceptibility.

Destroyed components of the hip joint implant.

Possible combinations of materials in endoprostheses:

ceramics + polyethylene;
metal + polyethylene;
metal + ceramics;
metal + metal.

Fact! Plates and pins for fixing bone fragments are made of metal alloys. The same applies to external fixation devices (Illizarov type) and clips that are placed on vessels.

Composition of artificial joints:

cobalt;
chromium;
molybdenum;
titanium;
zirconium;
tantalum;
niobium.

Having familiarized yourself with the composition, you can understand how it will behave in resonance tomograph. The magnetic properties of each endoprosthesis are determined not only by the material from which it is made, but also by its shape and size. Steel pins and plates longer than 20 cm can heat up above the permissible limit.

Fact! Products containing large amounts of nickel and cobalt interact especially actively with a magnetic field. This means that diagnostics with such endoprostheses should be performed with extreme caution.

Manufacturing companies

Over the past 20 years, medicine has mainly used implants made from chromium-cobalt alloys (as we have already found out, these metals actively react to a magnetic field). Many models made from better materials have appeared on the market. They are better tolerated by patients and do not cause allergies or MRI problems.

Table 2.

Company manufacturer	Characteristics and Application	Behavior of implants during MRI diagnostics
Biomet	Produces high-quality implants that take root well and do not cause allergic reactions.	Due to their small size and low magnetic susceptibility, they do not interfere with MRI.
Zimmer	It produces products not from titanium, but from tantalum. The implants have a porous coating and fuse perfectly with the bone tissue.	They do not cause unexpected complications during magnetic resonance imaging and do not distort the results of the study.
Johnson&Johnson	The company produces implants using all available standards and technologies.	Do not interact with magnetic field. When available, MRI is absolutely safe.
Smith&Nephew	Manufactures endoprostheses from an alloy containing zirconium and niobium.	Smith&Nephew implants are hypoallergenic and practically do not interact with the magnetic field.
Stryker	World-famous company of beta-titanium endoprostheses and fixators for internal osteosynthesis.	Owners of Stryker implants can undergo MRI without any worries. Additional measures precautions may only be necessary if there are several large prostheses.
Aesculap	Produces endoprostheses from titanium, zirconium ceramics, chrome-cobalt alloys.	Most implants can easily withstand magnetic resonance imaging.

If you have a prosthesis from one of the companies listed in the table, you can do an MRI without the slightest fear. However, undergo the study without preliminary consultation You don't need a doctor anyway.

Contraindications to the procedure

If prostheses, pins and plates are firmly connected to the bone tissue and cannot move, then implants of other locations can easily move under the influence of a magnet. Therefore, it is STRICTLY PROHIBITED to conduct magnetic resonance imaging if they are present.

Implants that cannot be used for MRI:

artificial heart valves;
stents and clips on vessels of any location;
middle or inner ear implants;
pacemakers;
artificial lens;
Illizarov apparatus;
insulin pump;
large metal implants.

How to find out if you can have an MRI

Remember that an MRI can be done with the permission of a specialist. Only he will determine whether you need this research and whether it will harm you. Perhaps the doctor will make a diagnosis without magnetic resonance imaging. Spinal spondylosis and deforming osteoarthritis of stages II-IV can be detected using conventional radiography.

Comparison of methods visual diagnostics. MRI is on the right.

Possible complications and precautions

MRI in the presence of electronic implants can seriously harm a person or even lead to his death. Performing the study on persons with coronary walls and clips on cerebral vessels can provoke massive bleeding, which will lead to death. Endoprostheses made from some alloys may move out of place or heat up during an MRI, causing burns.

MRI installation before the procedure.

People with certain types of implants are strictly prohibited from undergoing magnetic resonance imaging. But for patients with implants made of “dangerous” alloys, you can still try to perform the study. As a precaution, a button is placed in the person's hand. If he feels strong burning sensation, then clicks on it, and the study is stopped.

Fact! Metal prostheses tend to “fade”, making the image of nearby tissues unclear. Therefore, it is pointless to try to obtain an MRI image of the replaced joint or bone held together by fonts or plates.

In the human musculoskeletal system knee-joint is the most overloaded. It often accounts for the bulk of the body, so it is more vulnerable to disease and is more likely to be destroyed than others.

Under the influence of age and various factors(gaps internal meniscus knee, injuries, infectious and inflammatory processes, hypothermia), the cartilage tissue becomes thinner, and the end bones begin to rub against one another. This provokes injury, limits movement in the joint and causes excruciating pain to the person.

If conservative methods Treatments are no longer able to cope with the problem, doctors offer the patient knee replacement.

The operation is indicated in the following situations:

the presence of arthrosis, that is, degenerative-dystrophic diseases of the joint;
rheumatoid polyarthritis;
post-traumatic abnormal fusion of the bones included in the knee joint.

Endoprosthetics surgery lasts on average 2 hours. The patient is given general anesthesia or a nerve block is performed, which within 24 hours after surgical intervention continues to relieve pain.

To penetrate the joint, an incision is made above it, knee cap carefully moves to the side. The doctor removes excess bone formations, formed as a result of friction of the end bones against each other. These growths are a kind of protective reaction of the body.

In addition, the surgeon weakens the tension of the periarticular soft tissues, which returns diarthrosis to its original state.

Worn out remains cartilage tissue It is carefully cut off, and a perfectly fitted prosthesis is installed in its place. Moreover, the end bones are covered with special metal attachments:

on tibia a titanium plate is placed;
on the femur - an anatomically adapted prosthesis.

Additional inserts are attached to the titanium plate to ensure smooth movement in the joint. Special bone cement is used to attach the knee joint prosthesis. In some cases, cementless fixation is used. The operated joint is then sutured and immobilized using plaster cast or tires.

The operation to replace knee diarthrosis provides the patient with complete freedom of movement and relief from excruciating pain.

Advantages and disadvantages of prosthetics

Knee replacement has its advantages and disadvantages. The undoubted advantages include the disappearance of pain and lameness and the return of full functionality to the joint.

TO negative factors endoprosthetics includes the likelihood of developing an infection, although statistics indicate that the percentage of the likelihood of such a course of events is very low.

Rehabilitation after endoprosthetics takes a fairly long period of time - about two months. During this time, the patient must get used to the prosthesis and learn to control it freely.

Many doctors are supporters of arthroscopy - this is an operation with minimal trauma. In addition, recovery after arthroscopy occurs much faster than after conventional prosthetics.

Indicated for minor injuries in the joint, when restoration of cartilage tissue in the knee is still possible by taking special medications and a set of other measures.

During arthroscopy, the doctor:

will set the dislocation;
removes bone growths;
will ease the tension of the periarticular muscles.

In cases where the cartilage tissue is fundamentally damaged, this operation provides only temporary relief.

Patients who have undergone knee replacement often panic when the prosthesis jams. Unfortunately, such a situation is not excluded and is caused by improper functioning of the periarticular muscles.

If pain appears, you cannot tolerate it; you need to try to take the most comfortable position and try to move your leg. If the jamming does not disappear, then you need to contact an orthopedist. The situation is completely fixable and is not critical.

After surgery, there is a possibility of thrombosis and inflammation in the joint tissues. Therefore, the patient must first weigh all the pros and cons that prosthetics entails.

Knee replacement is strictly contraindicated for people suffering from cardiovascular pathologies and chronic joint infections.

What not to do after endoprosthetics

– the process is quite lengthy. However, the patient can take the first steps within 2-3 days. Playing sports after knee replacement is allowed only after several months, and you must first consult with your doctor and get his approval.

ABOUT big sport after endoprosthetics you will have to forget it forever. However physiotherapy Not only is it not prohibited, but it is also recommended. It is necessary for the development of the knee joint from the first days of recovery.

Physiotherapeutic procedures during knee replacement are prohibited in the first months; in the future, they are also undesirable. Due to the metal elements, magnetic resonance therapy can cause intense pain and damage to the tissue around the prosthesis.

Warm baths, saunas, steam baths and massages are also prohibited in the first months after prosthetics. These activities increase the likelihood of thrombosis. The diet for patients with an endoprosthesis should be gentle and consist of:

lactic acid products;
jelly.

After surgery to implant a knee joint endoprosthesis, a person can perform almost all the same actions that were available to him before replacing the joint.

But still there are some restrictions. For artificial joint The following actions are unacceptable:

excessive loads;
squats with weights;
running on an inclined and uneven road.

Rehabilitation after prosthetics

Rehabilitation of the knee joints takes different people different periods of time. Some patients begin to walk well within a week, while others need to full recovery it takes several months.

Properly selected physical activity is necessary to ensure that the joint gets used to the endoprosthesis and becomes overgrown with muscles. Rehabilitation of the patient in a special sanatorium-resort institution is recommended, where he will receive a full range of restorative procedures and measures.

Under supervision medical personnel and in a comfortable, relaxing environment the patient:

will undergo a course of physical therapy;
take mineral baths;
will swim in the pool;
will receive proper nutrition in the sanatorium canteen.

Therapeutic exercises after knee replacement are performed by the patient from the first days of recovery. At first, the movements should be light and gentle, but over time the doctor will create an individual complex consisting of muscle stretching and strengthening exercises. gluteal muscles And inner surface hips.

At first, gymnastics is performed only while sitting or lying down. However, when the joint is completely restored and there is no inflammation, standing and walking exercises are possible. Excellent results provides water aerobics and swimming, but these activities require permission from a doctor.

Knee replacement provides the patient with the opportunity to return to full life and feel free to move, and not disabled, immured in your own body.

Formation hip joint(TS), classified as simple synovial, occurs with the participation of two articulating bones - the ilium and the femur.

Cup-shaped recess on the outside pelvic bone(acetabulum) and the spherical bone of the femoral head together form the hip joint, which is a kind of hinge structure.

The head of the femur is connected to the femur by a neck, which is popularly called the “femoral neck.” The inside of the acetabulum and the femoral head itself are covered with a layer of special articular cartilage (hyaline).

Cartilage is an elastic and, at the same time, durable and smooth layer in the joint. Provides gliding during joint operation, releasing joint fluid, distributing the load during movement and the necessary shock absorption.

Around the head of the joint there is a capsule consisting of very dense and durable fibrous tissue.

The joint is secured using:

Bundles. External ones are attached at one end to femur, others - to the pelvic. And the internal ligament of the head of the pelvic bone connects the head itself with the acetabulum of the pelvic bone.
Muscle They surround the hip joint - the buttocks at the back and the femurs at the front. The better the muscular framework of the joint is developed, the less traumatic loads on it when running, unsuccessful jumps and moving heavy objects. It is also important that a good volume of strong working muscles delivers a sufficient volume of blood nutrients joint.

With the help of the hip joint, a person is simultaneously provided with the following functional capabilities:

body stability (support, balance);
variety of movements.

Why is the joint affected?

Obvious causes of damage include injury. Examples are femoral neck fracture, hip dislocation or subluxation.

Non-obvious diseases (infectious and non-infectious arthritis, osteoarthritis, inflammatory processes in the joint and periarticular tissues).

Let's look at the main ones:

inflammation of the pelvic joint - usually caused by arthritis of various etiologies, bursitis, synovitis, etc.;
pathology of joint deviation – dysplasia;
necrosis in the head of the vehicle in some areas bone marrow– non-infectious necrosis (avascular).

When and who needs a hip replacement?

The occurrence of pain in the hip joint is a signal that you should contact a professional to determine its causes. To do this on initial stage You should undergo an X-ray examination of the vehicle.

The solution to the problem for a worn out or irreversibly injured joint can be endoprosthetics, which may be indicated in the following cases:

non-healing fracture of the head of the vehicle;
fractures of the femoral neck or acetabulum in elderly patients;
aseptic necrosis;
tumor-like diseases of the TS;
deforming arthrosis of the third stage;
congenital hip dislocation, etc.

What types of operations does medicine offer?

In modern medicine, patients are offered three types of operations based on the type of prosthetics:

Replacement of vehicle surfaces - removal of cartilaginous layers from the acetabulum and replacement with a special artificial material and turning the head of the femur and putting a metal cap on it. Thanks to this replacement of articular surfaces, gliding is achieved that is close to natural.
Partial prosthetics is the replacement, for example, of the head of the pelvic joint with part of the femoral neck or articular bed.
Complete prosthetics – removal of the entire hip joint and replacing it with an endoprosthesis.

Types of endoprostheses

IN modern medicine Every day there are more than six dozen modifications of endoprostheses. They are divided according to the method of fixation and material. Three methods of fixation are offered today:

cementless – fixation occurs due to the fact that the joint bone grows into the surface of the joint;
cement – the endoprosthesis is fixed using special bone cement;
mixed (hybrid) - the cup is attached without bone cement, and the leg is attached with cement.

Modern combinations of materials from which prostheses are made are selected depending on the patient’s disease, age and lifestyle. They may be:

metal – metal;
metal - plastic of very high quality;
ceramics – ceramics;
ceramics - plastic.

Preparing for surgery

All necessary information to prepare for surgery will be provided to you by your attending physician.

However, there are moments for which the patient will have to prepare in advance (especially those who are lonely).

Since rehabilitation after a joint replacement continues at home, it is worth preparing your home for the postoperative recovery period:

purchase special equipment in the form of walkers or crutches, a special toilet seat, etc.;
stop taking certain medications (aspirin-containing, anti-inflammatory);
if necessary, reduce your weight;
do physical training;
visit the dentist;
give up bad habits(smoking).

Before the operation, the patient is required to complete Required documents(carrying out an operation for cash, under a contract within the framework of health insurance or under quotas of the federal program for the provision of free high-tech medical care); talk with an anesthesiologist about the most favorable anesthesia option for you; Stop eating at least 12 hours before surgery.

Joint replacement surgery

Modern advances in medicine make it possible to perform both open and minimally invasive surgeries for hip replacement.

Today, minimally invasive surgeries (MI) are the most common due to their minimal impact on the body.

To carry out MO you need:

high qualifications and professionalism of the surgeon and all medical staff;
availability of technical capabilities ( endoscopic equipment, high-tech materials).

Depending on the complexity of the operation (partial or complete prosthetics) its time can last from one to three to four hours:

anesthesia;
installation of a catheter in urethra(to prevent involuntary urination and control the amount of fluid released by the body);
an incision on the outer thigh (or two small ones - on the thigh and in the groin area);
peeling and shifting of tissues around the vehicle;
installation of a prosthesis;
restoring tissue integrity and suturing the wound.

The video clearly shows how hip replacement is performed.

Possible complications

Any surgery the body may have its own Negative consequences. Complications after the procedure most often occur in those undergoing surgery:

with large joint deformation;
with obesity or large muscle mass;
having a number of serious concomitant diseases - diabetes, blood diseases, heart diseases and the entire cardiovascular system, etc.

Joint replacement can cause the following complications:

Not correct positions endoprosthesis;
damage to nerve fibers and arteries;
disruption of the postoperative wound healing process;
the occurrence of infections;
fracture of the femur, dislocation or “popping out” of the prosthesis;
thrombotic phenomena in deep veins.

Rehabilitation after surgery

Rehabilitation after endoprosthetics can be long and take up to 6 months.

The patient should monitor the suture, body temperature and his sensations. Pain during this period may pass and return; the patient must be prepared for this and make efforts for a full recovery motor functions body.

For the first few days, the patient is prescribed painkillers and anti-inflammatory drugs.

Further rehabilitation after hip replacement consists of prescribing a special light gymnastics and breathing exercises.

To prevent cicatricial tightening of tendons and skin, to strengthen the muscle frame around the prosthesis, the patient is prescribed physiotherapy(physical therapy).

As indicated by reviews from patients who have undergone endoprosthetics, it is worth adhering to the recommendations of specialists as much as possible and then rehabilitation will be quick and almost painless.

How rehabilitation goes after hip surgery is described in detail in the video.

Where can I have surgery in Russia?

The operation of hip replacement is a high-tech process.

In 2015, the inclusion of high-tech medical care(VMP) into the compulsory health insurance system is provided for by the new legislative draft “On compulsory health insurance in the Russian Federation”.

Therefore, here we will not specify who will pay for the operation - the patient or the insurance companies.

The cost of hip replacement consists of the prosthesis and the operation itself. Today, the cost of the operation (total hip replacement) ranges from 210 to 300 thousand rubles (depending on the cost of the prosthesis).

Hip replacement in Russia is done as in federal budgetary institutions healthcare (FC of traumatology, orthopedics and endoprosthetics, regional clinical hospitals, research institutes) and in private clinics of the Russian Federation.

For example:

OAO "Medicine";
Family Clinic;
City Clinical Hospital No. 67 (Moscow);
KB MSMU im. Sechenov;
SM-Clinic;
Central Clinical Hospital of the Russian Academy of Sciences;
Multidisciplinary medical Center"K+31";
DKB named after Semashko;
Central Design Bureau No. 2 of JSC Russian Railways, etc.

Paget's disease is a disease in which there is pathological growth bone tissue skeleton and its deformation due to structural damage. This disease occurs as a result of a violation of the regenerative process in the bones; it is chronic. Otherwise, this disease is called “deforming osteodystrophy” or “deforming ostosis.”

Most often the disease affects the bones of the leg and spine, collarbone and skull, hip and humerus. People over 40 years of age and older suffer from this disease. for the most part men, women - 50% less often. The European population is most susceptible to this disease.

Medicine does not know the exact reasons of this disease, however, there is an assumption that the following factors contribute to its occurrence:

various conditions leading to disturbances in the metabolism of phosphorus and calcium in the body;
past viral diseases;
the presence of viruses in the body in the inactive phase;
hereditary predisposition.

Sometimes the cause of Paget's disease is a combination of all of these causes. If a hereditary predisposition prevails, then it is advisable for family members of the patient to undergo an x-ray examination of the bones and monitor the level of alkaline phosphatase by taking a blood test. Special place in a number viral causes The development of this disease is attributed to the measles virus.

Paget's disease occurs in two forms: monoostotic and polyostotic. The monoosseous form of the disease is characterized by damage to one bone; in the polyostotic form, several bones are affected. The main difference between this type of disease and other bone diseases is that there are no generalized bone lesions - the disease exclusively affects individual parts of the skeleton. It is known that this bone disease causes a continuous process of change in bone tissue without the influence of any load. It is believed that the disease can develop into bone sarcoma.

In its course, the disease goes through three stages:

initial;
active;
inactive.

The initial or osteolytic stage is characterized by a peculiar resorption of certain areas of the bone, as a result of which hollow pits are formed at this place. During the active stage, this process continues and at the same time bone growth occurs - they begin to acquire a cellular structure.

In the third stage - inactive - bone tissue is replaced connective tissue, i.e. osteosclerosis develops. In this case, the surface of the bones becomes rough, due to their thickening, the mass decreases. If you were hit tubular bones, then they bend and bend. When the disease affects the bones of the skull, they thicken up to 5 cm, which in turn entails deformation of the face and head. In case of damage to the bones of the spine spinal column deformed and twisted.

The onset of the disease occurs without any symptoms; this asymptomatic course is quite long. Signs and symptoms of the disease appear gradually.

Its first manifestations can be detected when examining a patient for other pathological conditions, i.e., the disease is learned only when taking a blood test, when a change in the indicator responsible for metabolism in bone tissue - phosphatase - is accidentally detected. In addition, a sign of this disease is bone deformation.

Pain in the area of the affected bone is the main symptom of the disease.

The pain is usually continuous, aching and dull. Its peculiarity is that it does not subside after rest, but rather intensifies at rest. If the disease occurs near a joint, the patient may complain of osteoarthritis. In addition, there is stiffness of movement, and the mobility of joints in the affected bone is limited.

Upon close and detailed examination, swelling can be seen in the lesions, the skin in this area is changed - there is hyperthermia of a separate area and its redness. If the doctor feels the affected area, thickening of the bone and unevenness of its edges may be noted. With slight pressure on such a bone, it can break.

As a result of the disease, bone fragility and bone fractures are observed, even as a result of minor trauma. When the spine is damaged, the back becomes deformed and stooped. At the same time, the legs become bent and abnormal growth skull bones. Deformations of the bones of the skull and spine can cause hearing or vision loss. This can occur as a result of compression of the nerve endings by the deformed bones. For the same reason, the patient may complain of constant headaches, numbness of the limbs and a feeling of “goosebumps” on the skin.

Diagnosis of the disease occurs by biochemical analysis blood and x-ray examination skeleton bones. If the disease is present, the results of a blood test will indicate that the level of the enzyme alkaline phosphatase in the blood serum will be higher than normal. If such an increase is detected, it is necessary to regularly take blood tests to monitor possible changes.

X-ray examination is very reliable and informative method diagnosis of bone diseases.

If the disease is present, the image will show the following features:

the skull bones are enlarged;
loose bone structure;
increased intracranial pressure;
increase in the size of the tubular and pelvic bones;
thickening of the periosteal layer;
bone decay and deformation;
fractures.

Diagnosis of Paget's disease can be carried out using methods such as CT scan and MRI. Their use is advisable only in cases where x-ray no pathology was detected. IN diagnostic purposes Technetium bone scanning technique is also used. It allows you to identify foci of bone tissue with pathological changes and carry out dynamic monitoring of the course of the disease under the influence of treatment procedures.

Until the disease has manifested itself in full force and is asymptomatic, no treatment is required. Basically the disease requires symptomatic treatment. If pain occurs, analgesics and non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen) are used. In addition, the use of vitamin D and calcium is recommended.

If there is a change in gait caused by bone deformities lower limbs, your doctor may recommend the use of orthopedic products. In some cases, this disease requires orthopedic surgery - endoprosthetics or decompression. If the hip joint is significantly deformed, it can be replaced, as this will significantly improve the patient’s quality of life and relieve him of pain. This procedure is called endoprosthetics. Treatment of Paget's disease also includes exercises with physical activity. It is not recommended to carry out long time in bed, because the pain intensifies at rest.

A mandatory element of therapy is the use of special medicines, the main effect of which is aimed at slowing down the process of bone tissue destruction. This medications- bisphosphonates, their use should be long-term. These medications have their side effects and therefore their prescription should be carried out by a doctor.

Conclusion on the topic

So, bone disease affects mainly older people and is associated with a disruption in the process of bone tissue regeneration. Persons at risk of developing Paget's disease should undergo regular examinations. Its main symptoms are pain and bone deformation.

The disease cannot be completely cured, but it is quite possible to slow down its progression by for a long time. The disease stops its progression under the influence of treatment, but existing pathological changes irreversible. The duration of the course of treatment is approximately six months and is repeated as necessary.