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MRI Predicts Failure of Metal-On-Metal Hip Implants

By MedImaging International staff writers
Posted on 04 Jun 2013

Metal-on-metal hip implants can cause inflammation of the synovitis long before symptoms appear, and magnetic resonance imaging (MRI) can be used to detect this inflammation. A new study revealed that MRI can be used to identify implants that are going to fail before individuals become symptomatic.

The study’s findings are slated for publication in an upcoming issue of the Journal of Bone & Joint Surgery. “The study shows that synovitis exists in asymptomatic people in a fairly high prevalence,” said Hollis Potter, MD, chief of the division of magnetic resonance imaging at Hospital for Special Surgery (New York, NY, USA). “If that is the case, symptoms alone are insufficient to determine the health of an implant. You can’t wait for people to be sore before we evaluate them for this potential problem.”

The investigators reported that that MRI scans can help identify patients who need revision surgery before tissue sustains additional injury that makes a revision more difficult.

Hip resurfacing, a surgical option to total hip replacement (THR), involves positioning a metal cap over the head of the femur while a corresponding metal cup, similar to that used in a THR, is placed in the pelvic socket. The procedure preserves more of a patient’s thighbone than a conventional hip replacement, but the implants can cause synovitis. Until now, no objective data has existed regarding just how much inflammation these implants can cause. To fill this knowledge gap, investigators set out to assess the ability of MRI to identify and quantify adverse synovial responses in symptomatic and asymptomatic subjects following metal-on-metal hip resurfacing.

The researchers included the first 69 consecutive subjects (74 hips) referred from three surgical practices to the Hospital for Special Surgery for an MRI after a metal-on-metal hip resurfacing arthroplasty. Patients were classified as asymptomatic, having unexplained pain, or symptomatic with a mechanical cause. This latter classification included patients with pain caused by implant loosening, dislocation, periprosthetic fracture, or original faulty positioning of the implant.

All individuals underwent an MRI and then these scans were evaluated by two musculoskeletal radiologists, both of whom were blinded as to which group the patient belonged. X-ray images were also obtained for most patients. Wear of metal-on-metal implant surfaces produces metal wear debris in the form of very small microscopic particles, resulting in metal ion release, which may impact local tissue and other body systems. Therefore, chromium ion and serum cobalt levels measured closest to the date of the MRI scanning were recorded when available. Investigators also gathered demographic data, including sex, age, body-mass index, and length of time since arthroplasty.

Analysis of the MRIs identified synovitis in 68% of asymptomatic hips, 75% of symptomatic hips with a mechanical cause, and 78% of hips with unexplained pain. “What was really interesting about this study was that we found that synovitis was detected in the same amount in symptomatic and asymptomatic patients,” said Dr. Potter.

The average volume of synovitis was 5.0 cm3 in the asymptomatic group, 10.2 cm3 in the mechanical causes group, and 31.0 cm3 in the unexplained pain group. “The data show that there is a high prevalence of abnormal synovial response in both symptomatic and highly functioning, asymptomatic patients who have undergone metal-on-metal arthroplasty, indicating that symptoms alone are insufficient means by which to monitor patients,” Dr. Potter said.

There were no significant disparities in the radiographs or serum ion levels, demonstrating that these could not be utilized to forecast injury. “Many people focus on serum ion levels,” said Dr. Potter. “I think the direction of the pendulum is really changing now, away from serum ion levels and toward imaging, or at least not to focus so much on serum ion levels to predict potential damage. Cross-sectional imaging is the way to go, and specifically, MRI over CT [computed tomography] based on its superior soft tissue contrast.”

Stephanie Gold, BA, and Kevin Koch, PhD, from General Electric (GE) Healthcare (Chalfont St. Giles, UK) also participated in the study, and GE Healthcare provided funding for the scanning of asymptomatic subjects.

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54 (!!!!! 1087.9039764404): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

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56 (619.17304992676): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294746586 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 7597.9232788086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

58 (!!!!! 3947.0195770264): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

59 (!!!!! 4919.0521240234): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

60 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

61 (!!!!! 6871.9387054443): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (!!!!! 11718.034744263): SELECT fid FROM jos_deeppockets WHERE id=294746586 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294746586 AND published='1' LIMIT 1

63 (!!!!! 7970.0946807861): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (!!!!! 6150.0072479248): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 9254.9324035645): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 5378.0078887939): select jos_google_plus.link from jos_google_plus where cat=10

67 (!!!!! 1171.1120605469): select jos_linkedin.link from jos_linkedin where cat=10

68 (822.06726074219): SELECT fid FROM jos_deeppockets WHERE id=294746586 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294746586 AND published='1' LIMIT 1

69 (818.01414489746): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (!!!!! 1219.9878692627): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746586 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (576.97296142578): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746586 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (99.897384643555): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (!!!!! 3557.9204559326): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (60.796737670898): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (!!!!! 1191.1392211914): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (427.0076751709): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (781.05926513672): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (474.92980957031): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (293.97010803223): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (392.91381835938): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (154.01840209961): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (!!!!! 1142.0249938965): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (602.00691223145): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 4737.8540039062): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746586 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (684.02290344238): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746586 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (60.081481933594): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (!!!!! 1348.9723205566): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (509.97734069824): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (411.9873046875): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (!!!!! 1589.0598297119): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (519.99092102051): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (315.90461730957): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (258.20732116699): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (!!!!! 1176.118850708): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (201.94053649902): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (372.88665771484): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (44.822692871094): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (885.96343994141): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 2383.9473724365): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

105 (!!!!! 4073.8582611084): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

106 (!!!!! 1749.9923706055): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294746586 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (!!!!! 1190.9008026123): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294746586 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1569.9863433838): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

109 (!!!!! 2496.0041046143): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

110 (!!!!! 1447.9160308838): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294746586 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 7498.9795684814): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294746586 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1163.0058288574): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (!!!!! 11915.922164917): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (!!!!! 2047.061920166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

115 (!!!!! 3981.1134338379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

116 (!!!!! 1067.8768157959): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

117 (642.06123352051): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

118 (!!!!! 4356.1458587646): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

119 (453.94897460938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

120 (!!!!! 3921.0319519043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

121 (!!!!! 2254.0092468262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

122 (407.93418884277): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746586 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746586 AND type='deeppockets_item' AND published='1' LIMIT 1

123 (!!!!! 98643.064498901): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

124 (!!!!! 7988.9297485352): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

125 (!!!!! 7797.9564666748): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

126 (!!!!! 2894.1631317139): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

127 (!!!!! 8809.0896606445): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

128 (!!!!! 6592.0352935791): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

129 (!!!!! 3700.9716033936): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

130 (!!!!! 1609.0869903564): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

131 (613.92784118652): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

132 (!!!!! 3370.0466156006): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

133 (482.08236694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (507.11631774902): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (204.08630371094): SELECT name FROM jos_deeppockets WHERE id=212

136 (65.088272094727): SELECT name FROM jos_deeppockets WHERE id=212

137 (785.82763671875): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (697.13592529297): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (!!!!! 1407.8617095947): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

140 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

141 (375.98609924316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

142 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

143 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

144 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

145 (!!!!! 1102.9243469238): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

146 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

147 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

148 (33.855438232422): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746586 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746586 AND type='deeppockets_item' AND published='1' LIMIT 1

149 (30.040740966797): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

150 (26.941299438477): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

151 (29.087066650391): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

152 (!!!!! 3097.0573425293): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

153 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746586 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746586 AND published='1' LIMIT 1

154 (124.93133544922): select jos_twitters.link from jos_twitters where cat=10

155 (27.179718017578): select jos_facebook.link from jos_facebook where cat=10

156 (28.133392333984): select jos_google_plus.link from jos_google_plus where cat=10

157 (26.941299438477): select jos_linkedin.link from jos_linkedin where cat=10

158 (290.87066650391): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

159 (!!!!! 3050.0888824463): insert into jos_banners_delta values (14615,'2025-06-25 15:05:10','216.73.216.120','view'),(14202,'2025-06-25 15:05:10','216.73.216.120','view'),(14203,'2025-06-25 15:05:10','216.73.216.120','view')

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