Is it possible to do an MRI after endoprosthetics? MRI with endoprosthetic joints and implants. The influence of a magnetic field on implants. Where can I have surgery in Russia?

MRI of the hip joints is a relatively new method for studying the condition of human bones and internal organs. It was developed in the 70s of the last century and immediately gained universal recognition. Magnetic resonance imaging allows you to examine the musculoskeletal system and accurately determine the degree of pathological changes in any organs of a sick person. The benefit of this examination method is that it is completely harmless; even infants and pregnant women can have an MRI of the hip joint.

In order to undergo an MRI, the patient must go to the clinic for an appointment with a therapist.

The attending physician will refer the patient for examination - MRI of the hip joints, if the patient complains of symptoms such as:

• pain in the hips and lower back;
• numbness and feeling of loss of sensitivity;
• pain limits the ability to move the limbs;
• swelling of the legs;
• convulsions.

The scope of MRI is quite wide. This technique is used when it is necessary to examine large joints and cartilaginous tissues (elbow, shoulder, hip, etc.).

What does magnetic tomography show?

The anatomy of the bone structure of the hip joint changes in a person with age or as a result of injuries and diseases. The most accessible way to study such changes is fluoroscopy. However, MRI is a study that shows in more detail all pathologies and changes in the human body. In addition, tomography makes it possible to detect many diseases at a very early stage, which gives the sick person the opportunity to begin treatment in a timely manner.

Pain and discomfort in the hip area can be caused by pathological changes and injuries. In some cases, x-rays do not accurately diagnose diseases. MRI of the pelvic bones is better than an x-ray; it will show any fractures and cracks, and will detect signs of diseases that cannot be determined otherwise in the early stages:

• tumors in tissues and bones;
• arthritis;
• internal hemorrhages;
• necrosis;
• rheumatism;
• epiphysiolysis of the femoral head;
• Perthes disease.

This is not a complete list of diseases that can be detected as a result of tomography of the hip joint.

What diseases can be detected in the early stages using MRI?

A timely tomographic examination allows us to identify such dangerous diseases as coxarthrosis of the hip joint.

With coxarthrosis, gradual destruction of the surface of the joints and cartilage occurs. If treatment for this disease is not started in the early stages, then pathological changes will subsequently affect the structure of the musculoskeletal system, which will ultimately affect the patient’s ability to work and quality of life.

Coxarthrosis begins asymptomatically and may not make itself felt for many years. An MRI of the hip joint can detect it in the early stages. Indications for such an examination concern persons who, in the opinion of doctors, have signs of pathological changes in the pelvic bones.

Incidental findings that are detected only with MRI include enostosis, which occurs unnoticed and does not manifest itself with any symptoms. This change in bone structure appears as a small tumor-like formation ranging in size from 2 to 20 mm. It is extremely rare that enostosis reaches 4-5 cm.

How to Prepare for an MRI of the Hip

Patients are often concerned about how an MRI is done, how long the procedure takes, and how to prepare for it.

Before the procedure, you need to remove all metal jewelry, put away phones and watches. Clothes with metal zippers, decorative details and buttons are not suitable for this occasion. Women are not recommended to use decorative cosmetics before an MRI, as they may contain metal particles.

If the patient has metal dentures or pins, this must be reported to the medical staff.

In some cases, for example, during MRI to detect various tumor formations, the introduction of a contrast component is recommended.

An MRI of the hip joint lasts approximately half an hour, the procedure does not cause any discomfort and does not require complex preparations from the patient. Discomfort during the procedure occurs only in those patients who do not feel well in closed spaces.

MRI is a paid service, and in different clinics, examination of the hip joints costs from 4 to 15 thousand rubles.

Contraindications to MRI: relative and absolute

Since the operation of the tomograph is based on the use of a strong magnetic field, it is necessary to find out whether MRI can be prescribed to patients who have metal plates, screws, pins, or pacemakers?

To answer this question unambiguously, you need to know what metal the implants are made of and what shape they have.

When exposed to a strong magnetic field, metal parts in the human body can:

• shift,
• get very hot.

That is why people with clips on blood vessels are strictly prohibited from having MRI scans, since these devices can move out of place during the procedure.

MRI is contraindicated in patients who have:

• pacemaker;
• electronic middle ear implants;
• implants or hemostatic clips made of metal in the vessels of the brain;
• Ilizarov apparatus.

An absolute ban on conducting MRI examinations in all of the above cases is due to the fact that the radiation from a magnetic resonance imaging scanner can cause disturbances in the functioning of the heart and bleeding in the brain.

The relative prohibition is associated with the patient’s temporary conditions:

• the patient is taking nerve stimulants;
• the woman is in the third trimester of pregnancy;
• The patient was diagnosed with decompensated heart failure.

Persons suffering from claustrophobia are also not allowed to undergo examination using a tomograph, since they are not able to endure 30 minutes of staying in the cramped enclosed space of the device. A limitation for MRI is the presence of tattoos on the patient’s body made using dyes containing metals.

Is it possible to perform MRI on preschool children?

Whether an MRI can be performed on a child or a pregnant woman should be decided by the attending physician. In any case, for these categories of patients this examination method is more gentle than x-rays. The difficulty of carrying out the procedure for children is due to the child’s lack of understanding, for which he is forced to lie quietly in a curved space for 30 minutes.

Immediately before the procedure, it is necessary to have a conversation with the child, calm him down and tell him about the upcoming event. The event itself can be presented to the child as a game. Before and during the procedure, adults should remain calm and be friendly with the child. It is known that young children subtly sense the psychological state of their parents. If the baby's mother behaves nervously, the child will feel anxious and afraid.

Can MRI be performed on patients with a hip replacement or plate?

Experts believe that MRI can be performed on patients with an endoprosthesis or plate if it is known for sure that the latter are made of titanium alloys, since this metal does not heat up or shift under the influence of a magnetic field.

For patients undergoing endoprosthetics with products made from other metals, there are restrictions. Tomography of persons with a metal prosthesis is carried out under strict control. For this purpose, the patient is given a button, which should be pressed if the patient begins to feel discomfort and a strong burning sensation in the area of ​​the endoprosthesis.

Results of an MRI examination

At the end of the procedure, the patient receives an examination protocol, which records the tomograph readings. Based on this document, the attending physician makes an accurate diagnosis and prescribes treatment.

The study protocol contains photographs of the hip joint in different planes, which gives doctors the opportunity to more accurately determine the cause of the disease. Depending on the established diagnosis, the patient is referred for additional consultations to specialists:

• traumatologist,
• neurologist,
• rheumatologist,
• physiotherapist.

Magnetic resonance imaging has found wide application in traumatology and surgery. This technique is recognized as one of the most effective, as it allows specialists to get a complete picture not only of the bone structure, but also of the condition of the patient’s cartilage and soft tissues. For this reason, MRI is mandatory for all patients in preparation for surgery in order to identify possible complications.

An MRI machine, by generating a strong magnetic field around a person, is capable of examining many disorders and pathologies of organs and tissues, but it can have a negative effect on the body of patients who have metal foreign bodies. One of the contraindications for the MRI procedure is the presence of implants made of various metals and alloys. Implants are considered to be pins in bone tissue, joints, permanent structures, pacemakers, and dentures. Why do doctors recommend choosing a different examination method in the presence of metal implants? Is their presence an absolute contraindication for the procedure? If there are metal objects in the body, in particular titanium, is it possible to undergo an MRI or not?

MRI and metal plates

Depending on the relationship of any metal to the influence of a magnetic field, they are divided into diagmagnets (in the field they are subject to weak repulsion), paramagnetic (weakly attracted by the magnetic field) and ferromagnetic (strongly susceptible to the influence of the field).

In exceptional situations, the doctor may prescribe an MRI if the patient has metal plates. If there is metal in the body, the examination can only be carried out if its immediate location is outside the range of the magnetic field, or the diagnosis will be performed using low-field equipment. However, in the vast majority of cases, metal prostheses are a contraindication to the procedure.

In the presence of titanium plates in the leg and other parts of the body, diagnostics are carried out without restrictions, since titanium is paramagnetic and is not characterized by strong attraction in a magnetic field. MRI with a titanium prosthesis is as informative and harmless as without it.

MRI after stenting

After stenting, an MR examination is not only allowed, but also prescribed. Therefore, the answer to the question of whether it is possible to do an MRI after stenting is positive. But the specialist conducting magnetic resonance imaging must know exactly what material the stents are made of.

It is absolutely possible to carry out examinations with bioabsorbable stents, since they consist of a biopolymer - after a given time they are absorbed, but the lumen of the vessel is preserved.

In other cases, stents are made of inert metal alloys: stainless steel, cobalt alloys, etc. Note that the patient is required to strictly follow the instructions for the stent, i.e. if it states that MRI should not be done in the first few weeks after stenting, then this applies not only to the area where the stent is installed, but to the entire body. Even if it is not directly located in the apparatus tunnel, the magnetic field works equally strongly in the room where the tomograph is installed.

Sometimes immediate diagnosis is necessary when the presence of a stent is not known before MRI is performed because the patient does not have time to report them. Practice has confirmed that the materials currently used for the manufacture of stents are not ferromagnetic and do not respond to external field influences, and, therefore, are MRI-compatible.

Is it possible to do an MRI with iron crowns?

If you have old-style crowns made of iron, you cannot screen the brain and heart. The metal heats up significantly, which causes severe pain in the patient, deformation of the metal structure - the integrity of the implants may be compromised or they may fly off the teeth.

With crowns and dentures with metal-ceramics, screening of the brain and heart area is allowed, but there is a high probability of an unreliable result due to a distortion of the response to magnetic field signals.

Regardless of the type of alloys of crowns and prostheses, it is allowed to conduct MRI of the lumbar spine, abdominal organs and retroperitoneal space, pelvic region and extremities in closed-type devices.

When installing pins, high-strength titanium implants are often used. Their presence does not affect the reliability of the examination results; moreover, the size of the pins is so small that the magnetic field does not have any significant effect on them.

Metal crowns made of polymer alloys also do not distort magnetic field signals, however, you should check with your dentist about the possibility of conducting an MRI. Some structures heat up, so the procedure will cause significant discomfort to the patient.

If a patient has dental bridges installed, then they probably contain separate parts - pins, plates, screws of various sizes. For their manufacture, diamagnetic, ferromagnetic and paramagnetic materials are used - cobalt, iron alloy and nickel, which react differently to magnetic field signals. Therefore, you should check with your dentist what materials were used to make the prosthesis, and notify the tomography specialist - he will decide on the possibility of conducting an MRI.

Is it possible to do an MRI with braces?

Modern brace systems are made of expensive and durable alloys that do not deform under the influence of magnetic-nuclear radiation and cannot move or injure the patient’s oral mucosa.

Small structures do not distort tomograph signals and do not heat up; their response to a magnetic field is very weak.

You cannot do an MRI if a fairly voluminous structure - more than 20 cm - is secured with ferromagnetic retainers. In this case, the bracket may become hot.

Is it necessary to do an MRI if a bracket is swallowed to accurately determine its position in the intestine? It is impossible to swallow a large brace, but a small one will come out naturally. To speed up this process, you need to eat more viscous porridge and drink fluids.

Braces do not affect the patient's condition during MRI, but they can result in insufficiently reliable results when scanning the brain, heart area, thoracic or cervical spine.

In cases where it is urgently necessary to screen the brain and cardiac system, and doctors do not see an alternative to MRI, you should contact orthodontists and remove dental implants. After tomography, they are reinstalled in the required volume.

Is it possible to do MRI with endoprostheses and other implants?

What to do if the patient has various types of implants right in his body? First of all, this must be reported to the specialist conducting the examination, since many metals are ferromagnetic and can shift in the body under the influence of a magnetic field.

For an MRI with a steel wire in the body, everything is not so simple. Iron causes the magnetic field to deviate from a given direction, which leads to distortion of the resulting images and the appearance of artifacts (defects) on them. In addition, the needle can heat up, creating unpleasant sensations for the patient.

Also, the answer to the question whether it is possible to do an MRI with an endoprosthesis depends on what material it is made of. If it is titanium, then there are no restrictions. If it is made of ferromagnetic materials, then this is a contraindication for research. You can find out exactly what metal the implant is made of in the design passport, which is issued to the patient after prosthetics.

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The most complete answers to questions on the topic: “after joint replacement.”

• Inpatient rehabilitation
• Possible complications
• Forecast

Surgery is an important, but not the only stage in the fight against severe diseases of the knee joint. The most important part of treatment begins after the patient has been discharged from the clinic. This is when comprehensive rehabilitation after knee replacement surgery begins - a time when the health of the person operated on directly depends on his own efforts.

Knee arthroplasty

Recovery after endoprosthetics includes several areas, among which the leading role is played by therapeutic exercises, physiotherapeutic treatment and drug therapy on demand. Rehabilitation begins in the hospital immediately after surgery; upon discharge, the doctor gives the patient a detailed list of exercises and procedures that he needs to perform.

The rehabilitation program is developed individually for each patient, taking into account the severity of his illness, general physical fitness, the presence of concomitant pathologies and other factors. All this is done by a rehabilitation doctor or specialist in rehabilitation medicine. If this specialist is not available in your medical institution, you can also contact a traumatologist and orthopedist.

In more than 90% of cases, carefully following the recommendations of the attending physician allows you to well restore the functions of the knee joint and return it to its former mobility. However, this is only possible when the patient himself is interested in recovery and conscientiously undergoes rehabilitation, which lasts at least 3–4 months.

There are no fundamental differences between rehabilitation after knee replacement and after similar operations on other joints. The difference lies only in the specifics of the complex of therapeutic gymnastic exercises performed.

Rehabilitation at home

You can most successfully recover after surgery at home. This option is suitable for all patients, but in practice it is most often chosen by people aged 20–50 years. Effective rehabilitation at home is also possible for older people if their relatives or a specially trained instructor work with them.

There are three most important conditions for completing a rehabilitation program at home:

Moderation: exercises should be performed at an average pace and rhythm, in no case leading yourself to exhaustion.

Regularity: It is not so much the exercises that are critical, but the systematicity of the exercises.

Patience: a positive result will not appear immediately - you need to work to achieve it.

In addition to exercise, the rehabilitation program after knee replacement includes physical therapy and massage, which can be done at a local clinic or at home, as well as drug therapy prescribed by a hospital doctor.

Exercises to restore the knee joint

Therapeutic gymnastics after endoprosthetics has one single goal: to restore the function of the joint. It begins immediately after endoprosthetics surgery and includes a set of exercises of increasing complexity.

In the first 1–3 days, the patient learns to re-do basic movements, such as sitting on the edge of the bed, getting to his feet independently, and sitting on a chair. Also, already at this stage, it is recommended to learn to walk again - first within two or three steps from the bed, then to the toilet and back, and then short walks and even going up and down the stairs are acceptable. The patient should do these exercises with the help of medical personnel or relatives for backup, as well as with the use of crutches or a cane.

During the first 6–12 weeks after discharge, the recovering person learns to move around the apartment - first with outside help, then independently. It is extremely important to strengthen the skills of landing on a horizontal surface (chair, toilet) and rising from it. Another important skill is the ability to bend the operated leg at a 90-degree angle and the ability to balance on it for 10-15 seconds - this is necessary to make using the shower easier.

Other strengthening exercises to do:

• walking in place;
• alternate bending of the knees in a standing position;
• adduction and abduction of the hips in a standing position;
• alternately lifting and bending the legs at the knee joint while lying on your back.

Exercises to strengthen the knee joint. Click on photo to enlarge

After 12 weeks of regular exercise, the operated knee is already fully functional, but requires further strengthening. At this stage, it is recommended to engage in some kind of sport that does not require excessive physical exertion. The most beneficial exercises in this regard are walking, recreational cycling, rowing, swimming and yoga. Team sports, martial arts, running and tennis are strictly prohibited.

Assistive rehabilitation methods

Other methods of restoring the function of the knee joint (besides gymnastics) also significantly facilitate the healing of postoperative wounds, improve performance and reduce the severity of unpleasant symptoms.

• In the first days after surgery, you should apply an ice pack wrapped in a towel to your knee to reduce swelling and redness.
• Subsequently, under the strict supervision of a physician, painkillers and ointments can be used, especially before physical therapy sessions, since pain and discomfort may occur during the procedures.
• In some cases, massage is indicated, which is often used for arthrosis of the knee joint; You can do it yourself, but it is best to entrust it to a specialist. The massage includes rubbing, kneading, squeezing and stroking not only the knee, but also other parts of the body, including the lumbar region and thigh.

Auxiliary methods of rehabilitation after knee replacement

Inpatient rehabilitation

Unfortunately, restoring the functions of an operated knee joint at home is not available to everyone. Often the reason for the ineffectiveness of home rehabilitation is simple laziness, but sometimes this is impossible due to objective factors independent of the patient.

In this case, those recovering are recommended to undergo a rehabilitation program in specialized clinics involved in the recovery of patients after orthopedic and traumatological operations. They provide a wide range of different services, including:

• development of a therapeutic exercise program;
• individual and group exercise therapy classes;
• hydrotherapy;
• mud therapy;
• physiotherapeutic procedures, and other activities.

Rehabilitation procedures in a specialized clinic

It is quite difficult to obtain free rehabilitation after endoprosthetics, and in most cases it is much easier to undergo rehabilitation treatment in a private specialized clinic than in a public institution.

The cost of rehabilitation in private clinics varies widely and, as of summer 2016, ranges from 50,000 to 100,000 rubles for one course lasting 2 weeks.

Possible complications

In 70-80% of cases, the rehabilitation period after knee replacement goes smoothly and without any complications. In this regard, much depends on the quality of the endoprosthetics operation performed. Insufficient qualifications of the surgeon, difficulties in the individual anatomy of the knee joint, the presence of severe concomitant diseases - this and much more can lead to the development of complications such as:

• inflammatory process in the bones adjacent to the knee joint;
• infectious complications;
• thrombosis and embolism;
• damage to neurovascular bundles.

All these complications develop in less than 1% of patients and in the first week after surgery.

Directly during rehabilitation, complications may arise due to the side effects of pain medications. It is for this reason that they should be taken in short courses lasting no more than one week, in no case every day, with a break between courses of at least 2-3 days and always under medical supervision.

If during the exercises you feel severe pain in your knee and notice that it has lost its functionality, then you need to contact your doctor (rheumatologist, arthrologist) as soon as possible. This should also be done if you accidentally hit your operated knee joint.

Regardless of the severity of the underlying disease for which knee replacement was performed, the operation is well tolerated in more than 90% of patients. After just six months of carefully carried out rehabilitation, complete restoration of joint function is observed, and the patient can return to normal life.