Abstract
The predominant indications for revision surgery after total hip (THA) or knee arthroplasty (TKA) are an aseptic failure (AF) and prosthetic joint infection (PJI). Accurate diagnosis is crucial. Therefore, we evaluated prospectively a multidisciplinary diagnostic algorithm including multi-modal radionucleid imaging (RNI) and extended microbiological diagnostics. If the surgeon suspected PJI or AF, revision surgery was performed with multiple samples obtained in parallel for special culture procedures and later molecular analyses. Alternatively, if the underlying cause was not evident, RNI was scheduled comprising 99Tc—HDP SPECT/CT, 111In-labeled white blood cells combined with 99Tc-nanocoll bone marrow SPECT/CT, and 18F-FDG PET/CT. A multidisciplinary clinical team made a recommendation on the indication for a diagnostic procedure guided by RNI images or revision surgery. A total of 156 patients with 163 arthroplasties were included. Fifty-five patients underwent RNI. In all, 118 revision surgeries were performed in 112 patients: 71 on the indication of AF and 41 revision of PJI. Thirty-four patients were concluded with chronic pain, and revision surgery refrained. The effective median follow-up period was 13 months. A structured approach offered by the algorithm was useful for the clinician in the evaluation of patients with a failing TKA or THA. Surgical revision was possibly obviated in approximately 20% of patients where an explanation or cause of failure was not found. The algorithm served as an effective tool.
Highlights
Complications after total hip (THA) or knee arthroplasties (TKA) present an increasing challenge for the health services, primarily reflecting a rising number of primary surgeries [1]
We summarize major findings in 156 prospectively recruited patients representing
Surgical revision was possibly obviated in approximately 20% of patients presenting with a chronic problem where an explanation or cause of failure was not found
Summary
Complications after total hip (THA) or knee arthroplasties (TKA) present an increasing challenge for the health services, primarily reflecting a rising number of primary surgeries [1]. Diagnostics 2020, 10, 98 complications can be divided into a prosthetic joint infection (PJI), aseptic failure (AF) (most of which are implant loosening, instability, and polyethylene wear) [2], and an exclusion diagnosis of chronic pain. Previous studies have projected a threefold rise in the number of revision surgeries due to PJI by the year 2030 [9]. Cases with culture-negative infections pose a special challenge [11], and a causative role of low-grade infection in AF has been indicated in a number of studies [12,13,14,15]. Non-confirmation of a preoperative diagnosis of chronic infection by culture may leave a notion that the procedure was superfluous
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