Bone Scans After Total Knee Arthroplasty in Asymptomatic Patients

Hofmann, Aaron A.; Wyatt, Ronald; Daniels, A. U.; Armstrong, Lisa; Alazraki, Naomi P.; Taylor, Andrew

doi:10.1097/00003086-199002000-00031

Cited by 55 publications

(14 citation statements)

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“…Some patients underwent bone scintigraphy, even though this is not considered to be a reliable tool to diagnose loosening or a low-grade infection in the first two years after knee replacement. [11][12][13][14] Aspiration, which is considered a reliable method of identifying low grade infection, was undertaken in several knees. 15 It seems unlikely that any infection was overlooked as this was not diagnosed during the post-revision period, but some of the patients in group A may have suffered from pain caused by a low-grade infection.…”

Section: Discussionmentioning

confidence: 99%

Revision from unicompartmental to total knee replacement

Kerens¹,

Boonen

Schotanus

et al. 2013

The Bone & Joint Journal

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Although it has been suggested that the outcome after revision of a unicondylar knee replacement (UKR) to total knee replacement (TKR) is better when the mechanism of failure is understood, a comparative study on this subject has not been undertaken. A total of 30 patients (30 knees) who underwent revision of their unsatisfactory UKR to TKR were included in the study: 15 patients with unexplained pain comprised group A and 15 patients with a defined cause for pain formed group B. The Oxford knee score (OKS), visual analogue scale for pain (VAS) and patient satisfaction were assessed before revision and at one year after revision, and compared between the groups. The mean OKS improved from 19 (10 to 30) to 25 (11 to 41) in group A and from 23 (11 to 45) to 38 (20 to 48) in group B. The mean VAS improved from 7.7 (5 to 10) to 5.4 (1 to 8) in group A and from 7.4 (2 to 9) to 1.7 (0 to 8) in group B. There was a statistically significant difference between the mean improvements in each group for both OKS (p = 0.022) and VAS (p = 0.002). Subgroup analysis in group A, performed in order to define a patient factor that predicts outcome of revision surgery in patients with unexplained pain, showed no pre-operative differences between both subgroups. These results may be used to inform patients about what to expect from revision surgery, highlighting that revision of UKR to TKR for unexplained pain generally results in a less favourable outcome than revision for a known cause of pain.

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Section: Discussionmentioning

confidence: 99%

Revision from unicompartmental to total knee replacement

Kerens¹,

Boonen

Schotanus

et al. 2013

The Bone & Joint Journal

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“…Bone scintigraphy typically provides high sensitivity but exhibit variable specificity. An increased uptake can be seen many years after the implantation of TKA but the tracer uptake is generally mild or moderate and decreasing over time [6,7]. …”

Section: Discussionmentioning

confidence: 99%

An impinging remnant meniscus causing early polyethylene failure in total knee arthroplasty: a case report

2007

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The management of patients with an apparently normal functional total knee arthroplasty (TKA) suffering from unexplained persistent pain and swelling is a challenging issue. The usual causes of pain after total knee replacement are well known, but there are a small number of patients in whom its aetiology is obscure. Malfunction due to soft tissue impingement has rarely been reported. A patient with an unusual case of posterior soft tissue impingement secondary to a trapped posterior horn of a remnant medial meniscus after TKA and responsible for severe early polyethylene wear, is reported. The diagnosis was confirmed by arthroscopy. Treatment was performed by arthrotomy. The meniscus remnant was removed followed by total synovectomy and isolated exchange of the polyethylene insert. To our knowledge, this is the first well-documented case reporting this association. Case presentationA 63-year old male patient with a history of symptomatic osteoarthritis of the left knee underwent a Total Knee Arthroplasty (TKA) of posterior cruciate ligament retaining design (Kinemax, Stryker, Mahwah, New Jersey, USA) without a patella component. The postoperative course was uneventful. Three weeks later he presented to our out patient clinic with sudden swelling and discomfort of his left knee. Clinical examination demonstrated medial joint line tenderness and confirmed the patient's impression of joint effusion. Radiographs demonstrated a well-aligned TKA. All complaints, with exception of the knee effusion, declined progressively over a period of months. Two years postoperatively, the patient developed increasing pain and complained of "catching" of the knee. Physical examination showed a stable knee with a normal range of motion of 130 degrees flexion with no extension deficit. There was a moderate swelling and joint line tenderness medially. Standard radiographs showed a well-aligned TKA with no signs of loosening or polyethylene wear (Figure 1). Laboratory analysis including a complete blood count with differential, erythrocyte sedimentation rate, Creactive protein and knee aspiration for cell count and culture excluded infection. A technetium 99m diphosphonate bone scintigraphy showed an increased perfusion in the early phase and increased uptake in the static phase at the medial side of the femoral and tibial component and in the patella of the left knee (Figure 2).A diagnostic arthroscopy was performed to differentiate between a mechanical and a soft tissue related problem. Arthroscopy revealed a remnant of the posterior horn of the medial meniscus impinging between the posterior part of the femoral component and the polyethylene insert. There was also an important delamination of the anteromedial part of the insert with a crack at the ventral

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“…Normal increased tracer uptake may persist on a bone scan up to 1 year (and in some cases longer) after surgery, and the tracer uptake may subside to a baseline level regardless of cemented or in growth prosthesis, but this level is still approximately two times that of the reference femoral shaft. 72 Variable periprosthetic tracer uptake is often seen in the early years following surgery when the incidence of infection is higher. 73 This makes the planar bone scan alone less reliable in the diagnosis of infection.…”

Section: Figure 27mentioning

confidence: 99%