Combined bone scintigraphy with 99mTc-MDP and 99mTc-ciprofloxacin in differentiation of hip and knee prosthesis aseptic loosening and infection: A preliminary study

Pucar, Dragan; Janković, Zoran; Baščarević, Zvezdana; Starcevic, Srdjan; Cizmic, Milica; Radulović, Marija; Šišić, Marija; Dugonjic, Sanja; Jauković, Ljiljana; Ajdinovic, Boris

doi:10.2298/vsp151211150p

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“…Considering the most commonly used radiopharmaceuticals for the detection of PJI, The aim of this study was to confirm or reject good diagnostic accuracy in differentiation of aseptic loosening from PJI of hip and knee obtained in a preliminary study 22 , but now in a larger number of pts. This study also combined bone scintigraphy with the 99m Tc-MDP and 99m Tc-ciprofloxacin.…”

Section: Introductionmentioning

confidence: 92%

Rational and reliable diagnosis of periprosthetic hip and knee joint infection using two nuclear-medicine methods: 99mTc-ciprofloxacin and 99mTc-MDP scintigraphy

2021

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Background/Aim. There is a constant and dramatic increase in hip and knee prosthetic implantations worldwide. However, decrease in percentage of failed (infected) prosthetic implantations is not significant (0.5% up to 2%). The real challenge is whether loosening is resulted in aseptic inflammation or infection. The aim of the present study was to attempt to distinguish sterile inflammation from infection in patients with painful hip or knee prosthetic joint. Furthermore, the next objective was to determine the accuracy of cumulative bone scintigraphy with methylenediphosphonate (MDP) and ciprofloxacin in diagnosis of periprosthetic joint infection (PJI). Methods. Three-phase bone scintigraphy with the 99m Tc-MDP and 99m Tc-ciprofloxacin scintigraphy were used. Patient selection criterion for this study was a suspicion of PJI followed by painful and limited movement of prosthetic joint accompanied by elevated unspecific inflammatory factors. The total of 45 patients with implanted 39 hips and 24 knee prosthesis were included and evaluated. All prosthetic joints were examined (although some prosthetic joints were asymptomatic) and underwent plain radiography. An average time span between performed nuclear medicine imaging was 3-5 days. Three-phase 99m Tc-MDP bone scintigraphy was performed first.Scintigraphy with 99m Tc-ciprofloxacin was necessarily done with calculation of the accumulation index. The obtained results were confirmed by microbiological findings as a gold standard. Statistical analysis of the obtained results was done with SPSS version 20 software (descriptive statistics, χ 2 -test). Sensitivity, specificity and predictive values were also calculated. Results. Microbiologically confirmed PJI were in 16/39 hip prosthesis.Positive scintigraphy was obtained in 15/39 prosthetic hip joints. PJI was found using scintigraphy of knee, and microbiologically confirmed in all 13/24 suspected joints.Estimated sensitivity/specificity of the 99m Tc-MDP bone scintigraphy alone (for both joints) was 90%/69%, for 99m Tc-ciprofloxacin scintigraphy was 93%/97% and for cumulative results was 96.5%/97%. Conclusion. Cumulative 99m Tc-MDP scintigraphy with 99m Tcciprofloxacin scintigraphy increases the ability of differentiation of aseptic loosening from PJI with high accuracy of 97%. kombinovane rezultate (dobijene kombinacijom obe scintigrafije 96,5%/97. Zaključak.Kombinovana scintigrafija 99m Tc-MDP i 99m Tc-ciprofloksacin, povećava sposobnost razlikovanja aseptičnog labavljenja od PJI sa visokom tačnošću od 97%.

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Section: Introductionmentioning

confidence: 92%