Natural Postoperative Bone Metabolic Changes after Total Knee Arthroplasty Determined by Positron Emission Tomography Scans

Masakazu Kanetaka,Yukimasa Yamato,Soichiro Kaneko,Yorito Anamizu,Hiroshi Hamaji,Kenji Ishii,Kei Wagatsuma,Shinya Nakamura,Kimiteru Ito,Fumiaki Tokimura,Tsuyoshi Miyazaki

doi:10.4236/ojo.2018.812046

Masakazu Kanetaka, Yukimasa Yamato + Show 9 more

Open Access

https://doi.org/10.4236/ojo.2018.812046

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Abstract

Artificial joint replacement surgery is the orthopedic procedure of choice to relieve pain, correct joint deformities, and help patients resume everyday activities. However, the detailed mechanisms regulating peri-implant bone remodeling at the bone-prosthesis interface remain elusive. To address this gap in knowledge, we evaluated the natural postoperative course of bone metabolism by using [18F] NaF positron emission tomography (PET)/computed tomography in 57 patients (104 joints) who underwent asymptomatic total knee arthroplasty (TKA). First, we measured total tracer uptake around TKA to determine the total bone metabolism (TBM) and used the ischial tuberosity as the reference tissue for normalization of PET images. Second, we calculated the TBM ratio (TBMR) by dividing the TBM by tracer uptake in the reference tissue. A moderate increase in TBMR was observed 4 - 5 days after implantation, and its intensity reached the maximum on the seventh postoperative day. The TBMR showed no differences until 12 weeks, after which it decreased slowly and returned to the basal levels. The new parameter TBMR and the unique pattern of postoperative metabolic changes in the bone around the prosthesis may help set accurate interpretation criteria to diagnose complications such as loosening or infections.

Highlights

Total joint arthroplasty is a surgical procedure in which parts of an arthritic or damaged joint are removed and replaced with a metal, plastic, or ceramic device called prosthesis
Total knee arthroplasty (TKA) as well as total hip arthroplasty (THA) is the most commonly performed joint replacement procedures, replacement surgery can be performed on other joints as well, including the shoulder, elbow, wrist, and ankle
Two weeks after right total knee arthroplasty (TKA), a second positron emission tomography (PET) scan showed intense homogeneous uptake in all areas around the knee prosthesis, NaF uptake around the left TKA was of very similar magnitude compared with that in the first scan (Figure 1(b))

Summary

Introduction

Total joint arthroplasty is a surgical procedure in which parts of an arthritic or damaged joint are removed and replaced with a metal, plastic, or ceramic device called prosthesis. The prosthesis is designed to replicate the movement of a normal, healthy joint. Total knee arthroplasty (TKA) as well as total hip arthroplasty (THA) is the most commonly performed joint replacement procedures, replacement surgery can be performed on other joints as well, including the shoulder, elbow, wrist, and ankle. Knee replacement surgery was first performed in 1968, according to the American Academy of Orthopaedic Surgeons [1]. A recent study reported that TKA is one of the most successful procedures in medical practice, and the literature contains a number of reports describing prosthesis survival rates of more than 90% at the 30-year follow-up examination [2]. There is a non-zero chance of recurring pain after TKA due to complications such as infections or loosening

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