Abstract
Background: The aim of this prospective study was to assess the diagnostic value of nuclear imaging with 18F-FDG PET/CT (FDG PET/CT), combined 111In-WBC/99mTc-Nanocoll, and 99mTc-HDP SPECT/CT (dual-isotope WBC/bone marrow scan) for patients with chronic problems related to knee or hip prostheses (TKA or THA) scheduled by a structured multidisciplinary algorithm. Materials and Methods: Fifty-five patients underwent imaging with 99mTc–HDP SPECT/CT (bone scan), dual-isotope WBC/bone marrow scan, and FDG PET/CT. The final diagnosis of prosthetic joint infection (PJI) and/or loosening was based on the intraoperative findings and microbiological culture results and the clinical follow-up. Results: The diagnostic performance of dual-isotope WBC/bone marrow SPECT/CT for PJI showed a sensitivity of 100% (CI 0.74–1.00), a specificity of 97% (CI 0.82–1.00), and an accuracy of 98% (CI 0.88–1.00); for PET/CT, the sensitivity, specificity, and accuracy were 100% (CI 0.74–1.00), 71% (CI 0.56–0.90), and 79% (CI 0.68–0.93), respectively. Conclusions: In a standardized prospectively scheduled patient group, the results showed highly specific performance of combined dual-isotope WBC/bone marrow SPECT/CT in confirming chronic PJI. FDG PET/CT has an appropriate accuracy, but the utility of its use in the clinical diagnostic algorithm of suspected PJI needs further evidence.
Highlights
Total hip and knee arthroplasty (TKA and THA) surgeries are among the most clinically successful and cost-effective orthopedic procedures for end-stage degenerative, traumatic, and inflammatory joint disease
The purpose of our study was to investigate the diagnostic value of advanced nuclear imaging for patients with chronic problems related to knee or hip prostheses in a prospective interdisciplinary study
The strength of the study was the prospective design and multidisciplinary cooperation, serving as tools in personalized patient treatment. In this analysis of the patient subgroup, we report the diagnostic value of advanced hybrid nuclear imaging in patients with chronic problems after total hip or knee arthroplasty
Summary
Total hip and knee arthroplasty (TKA and THA) surgeries are among the most clinically successful and cost-effective orthopedic procedures for end-stage degenerative, traumatic, and inflammatory joint disease Complications such as chronic pain, prosthetic joint infection or aseptic failure remain a challenge for health services, and timely identification and initiation of treatment are crucial. In Scandinavian countries, the leading indication for revision surgery is AF followed by PJI, but as previously reported, patients undergoing revision surgery are at an 8 times higher risk of subsequent PJI than patients undergoing primary arthroplasty [2–4] The aim of this prospective study was to assess the diagnostic value of nuclear imaging with 18F-FDG PET/CT (FDG PET/CT), combined 111In-WBC/99mTc-Nanocoll, and 99mTc-HDP SPECT/CT (dual-isotope WBC/bone marrow scan) for patients with chronic problems related to knee or hip prostheses (TKA or THA) scheduled by a structured multidisciplinary algorithm. FDG PET/CT has an appropriate accuracy, but the utility of its use in the clinical diagnostic algorithm of suspected PJI needs further evidence
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