Key safety considerations for MRI examination of patients with an orthopaedic implant.

Introduction: Magnetic resonance imaging (MRI) provides superior soft tissue contrast, multiplanar capabilities, and avoids ionizing radiation, making it valuable for evaluating orthopedic conditions. Despite persistent concerns regarding MRI safety with orthopedic instrumentation, this imaging modality is particularly well-suited to evaluate pain and weakness following hardware placement. This review examines the evidence regarding safety and efficacy of MRI in patients with orthopedic implants.

Areas covered: This review covers potential safety risks including device displacement and thermal energy deposition during MRI examinations, artifact reduction techniques such as multispectral imaging, and clinical applications in diagnosing complications surrounding orthopedic hardware. Evidence demonstrates MRI's utility in detecting adverse local tissue reactions, periprosthetic infections, implant loosening, and soft tissue complications following joint arthroplasty.

Expert opinion: Based on extensive clinical experience with thousands of patients, MRI is both safe and diagnostically valuable for monitoring patients with orthopedic hardware. Modern orthopedic implants almost exclusively use non-ferromagnetic materials, eliminating displacement risks. While RF-induced heating requires consideration, no confirmed reports exist of tissue damage from MRI-induced thermal deposition near orthopedic devices. MRI serves as a particularly valuable screening tool for identifying early-stage soft tissue reactions and osteolysis, especially critical in scenarios where proactive monitoring can significantly improve outcomes.