Diagnostic accuracy of SPECT/CT arthrography in patients with suspected aseptic joint prostheses loosening

Bo Bao,Edward C O Masson,Jonathan T Abele,Crystal S Liu

doi:10.1186/s41824-021-00098-y

Bo Bao, Edward C O Masson + Show 2 more

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https://doi.org/10.1186/s41824-021-00098-y

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Abstract

PurposeTo evaluate the diagnostic accuracy of SPECT/CT arthrography in patients with suspected aseptic prosthesis loosening following hip and knee arthroplasty.MethodsA retrospective review of 63 SPECT/CT arthrogram studies (36 knees and 27 hips) between February 1, 2013, and July 1, 2018, was conducted. All patients underwent clinical and radiologic evaluation as part of their assessment for persistent pain following hip and knee arthroplasty. The detection of tracer activity along the bone-prosthetic interface on SPECT/CT suggests aseptic loosening. Operative assessment as well as clinical/radiologic follow-up at a minimum of 1 year was used as the reference standard.ResultsThe sensitivity and specificity of SPECT/CT for detection of aseptic loosening was 6/7 (86%) and 55/56 (98%), respectively. This gives a positive predictive value (PPV) of 6/7 (86%), a negative predictive value (NPV) of 55/56 (98%), and a diagnostic accuracy of 61/63 (97%).ConclusionSPECT/CT arthrography has a high diagnostic accuracy (97%) in the evaluation of loosening of both hip and knee arthroplasties in patients with persistent post-procedural pain.

Highlights

Hip and knee arthroplasties are commonly performed procedures for the management of osteoarthritis (Katz et al 2010; Ethgen et al 2004)
While hip and knee arthroplasties are successful in most patients, persistent pain is a common complication that affects up to 44% of patients with total hip arthroplasty and 27% of patients with total knee arthroplasty (Wylde et al 2011; Piscitelli et al 2013; Becker et al 2011)
Our data confirms that SPECT/Computed tomography (CT) arthrography has a high diagnostic accuracy for detecting aseptic loosening in patients with persistent pain following primary hip and knee arthroplasties

Summary

Introduction

Hip and knee arthroplasties are commonly performed procedures for the management of osteoarthritis (Katz et al 2010; Ethgen et al 2004). In the USA, over 7.2 million individuals have received hip and knee replacement surgeries (Maradit Kremers et al 2015). The rate of joint replacement surgery is projected to increase further in the few years (Singh et al 2019). While hip and knee arthroplasties are successful in most patients, persistent pain is a common complication that affects up to 44% of patients with total hip arthroplasty and 27% of patients with total knee arthroplasty (Wylde et al 2011; Piscitelli et al 2013; Becker et al 2011). Post-surgical pain can be due to a variety of causes, aseptic loosening is the most common complication of hip and knee arthroplasty requiring major revision surgery (Sharkey et al 2014). Bao et al European Journal of Hybrid Imaging (2021) 5:4 accurate detection of aseptic loosening is essential in guiding management decisions for persistent post-arthroplasty pain

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