The use of labelled leucocyte scintigraphy to evaluate chronic periprosthetic joint infections: a retrospective multicentre study on 168 patients

Philippe Blanc,Anne-Sophie Salabert,Eric Bonnet,Jacques Monteil,Gérard Giordano,Pierre Payoux

doi:10.1007/s10096-019-03587-y

Philippe Blanc, Anne-Sophie Salabert + Show 4 more

Open Access

https://doi.org/10.1007/s10096-019-03587-y

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Abstract

Labelled leucocyte scintigraphy (LS) is regarded as helpful when exploring bone and joint infections. The aim of this study was to evaluate the utility of LS for the diagnosis of chronic periprosthetic joint infections (PJIs) in patients exhibiting arthroplastic loosening. One hundred sixty-eight patients were referred to centres for treatment of complex PJI. One hundred fifty underwent LS using 99mTc-HMPAO (LLS); 18 also underwent anti-granulocyte scintigraphy (AGS) and 13 additional SPECT with tomodensitometry imaging (SPECT-CT). The LS results were compared with bone scan data. For all, the final diagnoses were determined microbiologically; perioperative samples were cultured. LS values were examined, as well as sensitivity by microorganism, anatomical sites, and injected activity. LS results were also evaluated according to the current use of antibiotics or not. The sensitivity, specificity, and positive predictive value of LLS were 72%, 60%, and 80%, respectively. LLS performed better than did AGS. SPECT-CT revealed the accurate locations of infections. The sensitivity of LS was not significantly affected by the causative pathogen or the injected activity. No correlation was evident between the current antibiotic treatment and the LS value. The test was more sensitive for knee (84%) than hip arthroplasty (57%) but was less specific for knee (52% vs. 75%). Sensitivity and specificity of LLS varied by the location of infection bone scan provide no additional value in PJI diagnosis. Current antibiotic treatment seems to have no influence on LS sensitivity as well as labelling leukocyte activity or pathogens responsible for chronic PJI.

Highlights

Level of evidence: IIIDepartment of Nuclear Medicine, Pierre-Paul Riquet Hospital, CHU Purpan, Place du Dr Baylac, TSA 40 031, 31059 Toulouse Cedex 9, FranceDepartment of Nuclear Medicine, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042 Limoges Cedex, FranceMobile Team of Infectious Disease, Joseph Ducuing Hospital, 15, Rue de Varsovie, 31027 Toulouse Cedex 3, FranceOrthopedic Surgery and Traumatology, Joseph Ducuing Hospital, 15, Rue de Varsovie, 31027 Toulouse Cedex 3, FranceToNIC, Toulouse NeuroImaging Centre, CHU Purpan – Pavillon Baudot, Place du Dr Baylac, 31024 Toulouse Cedex 3, FranceAs life expectancy increases, total hip and knee joint replacements are becoming more common; these procedures improve quality-of-life
The aim of the present study was to evaluate the usefulness of leucocyte scintigraphy ([LS], meaning labelled autologous leucocyte scintigraphy (LLS) and anti-granulocyte scintigraphy (AGS)) in relation with the pathogens involved in periprosthetic joint infections (PJIs)
We found that the Se of LS varied by the location of the infection

Summary

Introduction

Level of evidence: IIIMobile Team of Infectious Disease, Joseph Ducuing Hospital, 15, Rue de Varsovie, 31027 Toulouse Cedex 3, FranceOrthopedic Surgery and Traumatology, Joseph Ducuing Hospital, 15, Rue de Varsovie, 31027 Toulouse Cedex 3, FranceToNIC, Toulouse NeuroImaging Centre, CHU Purpan – Pavillon Baudot, Place du Dr Baylac, 31024 Toulouse Cedex 3, FranceAs life expectancy increases, total hip and knee joint replacements are becoming more common; these procedures improve quality-of-life. Mobile Team of Infectious Disease, Joseph Ducuing Hospital, 15, Rue de Varsovie, 31027 Toulouse Cedex 3, France. Orthopedic Surgery and Traumatology, Joseph Ducuing Hospital, 15, Rue de Varsovie, 31027 Toulouse Cedex 3, France. Total hip and knee joint replacements are becoming more common; these procedures improve quality-of-life. The financial costs are high, despite the low frequencies of complications (which arise after 1% of total hip arthroplasties [THAs] and 2% of total knee arthroplasties [TKAs]) [1]. When the clinical signs of infection are not obvious, it can be very challenging to distinguish delayed infection from mechanical loosening. Joint aspiration data are unreliable in cases of chronic infection [2, 3]. Plain radiographs cannot differentiate septic from aseptic loosening, and

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