Radionuclide imaging of the painful hip arthroplasty

Abstract

Two major complications of hip replacement are loosening and infection. Reliable differentiation between these pathological processes is difficult since both may be accompanied by similar symptoms. Our aim was to assess the diagnostic ability of triple-phase bone scanning (TPBS) and positron-emission tomography (PET) to detect and differentiate these complications in patients with a hip arthroplasty. Both TPBS and PET were performed in 63 patients (92 prostheses). The radiotracer for PET imaging was (18)F-fluorodeoxyglucose (FDG). Image interpretation was performed according to qualitative and quantitative criteria although the final diagnosis was based upon either surgical findings or clinical follow-up. The sensitivity, specificity and accuracy of PET was 0.94, 0.95 and 0.95 respectively, compared with 0.68, 0.76 and 0.74 for TPBS. We found that an image interpretation based exclusively upon quantitative criteria was inappropriate because of its low selectivity. The histological examination indicated that increased periprosthetic uptake of FDG in patients with aseptic loosening was caused by wear-induced polyethylene particles and the subsequent growth of aggressive granulomatous tissue.

Leukocyte and bacteria imaging in prosthetic joint infection

“…Increased uptake in the neck of the prosthesis, accompanied by uptake around the whole cup of the prosthesis and/or around the whole shaft, fits with aseptic prosthetic loosening. Finally, infection is characterised by increased uptake in all the abovementioned prosthesis-bone interfaces -including periprosthetic soft tissues (Reinartz et al, 2005). Nevertheless, these criteria have not been accepted by all, and are also criticised.…”

Critical Role of 18F-Labeled Fluorodeoxyglucose PET in the Management of Patients with Arthroplasty

“…Vanquickenborne and colleagues [43] interpreted PET images to represent infection when FDG uptake around the prosthesis is two scores higher than that in the contralateral distal femur. In contrast, Reinartz and his coworkers [10,50] considered infection as the diagnosis when increased FDG activity in the periprosthetic soft tissue and arthroplasty interface was observed. Our group [49,51] has used similar criteria for infection as those of Reinartz and his coworkers [10,50].…”

“…Most infections cannot be diagnosed accurately by bone and gallium scans, however [9]. Although three-phase bone scintigraphy has been used in the evaluation of painful prosthesis replacement, it lacks adequate accuracy [10]. Indium 111-labeled leukocyte scintigraphy, when combined with technetium (Tc)-99m-sulfur colloid bone marrow imaging, may provide reasonable accuracy for the detection of infection after arthroplasty [11][12][13][14].…”

“…The largest sample of patients with hip prostheses examined with FDG-PET was reported in a recent publication by Reinartz and colleagues [10]. In this study, these investigators recruited 63 patients with 92 hip prostheses with possible periprosthetic infection.…”

A retrospective analysis of the accuracy of radioactively labeled autologous leukocytes in patients with infected prosthetic joints

“…The accuracy of detecting infection in a knee prosthesis reported by Zhuang et al [47] was quite low at 77.8%. When it comes to infection following hip arthroplasty, the accuracy ranges between 89-95% [47][48][49]. On the other hand, studies have shown contradictory results when it comes to 18 F-FDG-PET-(CT) in prosthetic joint infection.…”