CME OnDemand: Novel Imaging and MIS Techniques in Foot and Ankle Care (2026)-Magnetic Resonance Imaging of Total Ankle Arthroplasty State-of-The-Art Assessment of Implant-Related Pain and Dysfunction

Magnetic Resonance Imaging of Total Ankle Arthroplasty State-of-The-Art Assessment of Implant-Related Pain and Dysfunction

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This article reviews state-of-the-art MRI evaluation of patients with pain or dysfunction after total ankle arthroplasty (TAA), focusing on modern metal artifact reduction (MAR) techniques that make periprosthetic MRI clinically useful. TAA is an increasingly used alternative to ankle arthrodesis for end-stage ankle arthritis, offering motion preservation and improved function, but it carries higher complication and failure rates than hip and knee arthroplasty, creating a need for accurate imaging surveillance and problem-solving.<br /><br />The authors summarize common third-generation implant designs (typically cobalt-chromium/titanium tibial and talar components with an interposed polyethylene insert) and highlight MRI-identifying features of widely used systems such as STAR, Salto Talaris, INBONE, and Trabecular Metal implants. They compare imaging modalities: radiographs are first-line for component position and alignment; CT is better for early osteolysis, interface lucency, and subtle fractures but has limited soft-tissue assessment; SPECT(-CT) can help evaluate bone-implant activity but lacks specificity due to postoperative remodeling.<br /><br />A central emphasis is that conventional MRI is often degraded by metal artifacts, whereas advanced MAR MRI (notably SEMAC and MAVRIC, often with compressed sensing acceleration) markedly improves visualization of implant interfaces, adjacent bone, and soft tissues. Practical protocol elements include turbo/fast spin echo sequences, high receiver bandwidth, STIR fat suppression, thin slices, and preference for lower field strength when possible; IV contrast is rarely needed.<br /><br />The paper details normal postoperative MRI findings (e.g., transient edema/synovitis, pseudocapsule appearance, small simple effusion) and the MRI appearance of key complications: aseptic loosening and failed osseointegration, “ballooning” osteolysis, periprosthetic joint infection (complex synovitis and soft-tissue edema, sinus tracts, osteomyelitis features), arthrofibrosis, stress reactions and radiographically occult nondisplaced fractures, heterotopic ossification, polyethylene fracture/displacement, and tendon, ligament, and nerve injuries (including neuroma and transection). Overall, MAR MRI is presented as a high-accuracy problem-solving tool when radiographs are negative or equivocal, informing management, surgical planning, and prognosis.

Keywords

total ankle arthroplasty

periprosthetic MRI

metal artifact reduction

SEMAC

MAVRIC

compressed sensing MRI

aseptic loosening

periprosthetic joint infection

osteolysis

polyethylene insert failure