Use of Anti-Granulocyte Scintigraphy with 99mTc-Labeled Monoclonal Antibodies for the Diagnosis of Periprosthetic Infection in Patients after Total Joint Arthroplasty: A Diagnostic Meta-Analysis

Dan Xing,Jie Wang,Xinlong Ma,Yang Chen,Yang Yang,Jianxiong Ma,Cordula M Stover

doi:10.1371/journal.pone.0069857

Abstract

The accurate diagnosis of periprosthetic joint infections (PJI) is crucial for therapy and the prevention of complications. No diagnostic test of PJI is 100% accurate. The aim of this study was to assess the use of anti-granulocyte scintigraphy using 99 mTc-labeled monoclonal antibodies to diagnose PJI after total joint arthroplasty. A systematic search of all relevant studies published through January 2013 was conducted using the MEDLINE, EMBASE, OVID, and ScienceDirect databases. Observational studies that assessed the accuracy of the anti-granulocyte scintigraphy with monoclonal antibodies or antibody fragments labeled with technetium 99 m in diagnosis for PJI and provided data on specificity and sensitivity were identified. Standard methods recommended for meta-analysis of diagnostic accuracy were used. Nineteen studies were eligible for inclusion. The results demonstrated that the area under the summary receiver operator curve was 0.88, and the diagnostic accuracy (Q*) was 0.81. Additionally, the diagnostic odds ratio (DOR) was 18.76 with a corresponding 95% confidence interval of 10.45–33.68. The pooled sensitivity and specificity of the diagnostic method for the diagnosis of PJI were 83% and 79%, respectively, while the pooled positive likelihood ratio (PLR) was 3.56, and the negative likelihood ratio (NLR) was 0.26. Anti-granulocyte scintigraphy using 99 mTc-labeled monoclonal antibodies has a reasonable role in the diagnosis of PJI after total joint arthroplasty. Due to the limitations of the present meta-analysis, additional high-quality original studies are required to confirm the predictive value.

Highlights

Joint loosening, heterotopic ossification, periprosthetic fractures, luxation, osteolysis and periprosthetic joint infections (PJI) are the failures of joint arthroplasty or complications following joint arthroplasty
Search Strategy We performed a systematic search of the Medline, Embase, ScienceDirect, and OVID databases to identify epidemiological studies published through January 2013 that were related to the diagnostic test accuracy of anti-granulocyte scintigraphy with 99 mTc-monoclonal antibodies in the identification of PJI after total joint arthroplasty
The following search terms were adopted for the search of each database: anti-granulocyte scintigraphy, leukocyte scintigraphy, monoclonal antibody, sulesomab, BW 250/183, prosthesis infection, and total joint arthroplasty

Summary

Introduction

Heterotopic ossification, periprosthetic fractures, luxation, osteolysis and periprosthetic joint infections (PJI) are the failures of joint arthroplasty or complications following joint arthroplasty. PJI occur in 1–2% of the primary implants and in 3–5% of revision implants [1,2], and PJI may be the most devastating complication of total joint arthroplasty. The accurate diagnosis of PJI is crucial for therapy and the prevention of complications. A failure to recognize PJI may lead to the unintended implantation of a new prosthesis into an infected surgical site. Without the appropriate debridement of the joint or antibiotic treatment, this implantation may result in persistence of the infection and early failure of the revision surgery. An erroneous diagnosis of PJI in the absence of infection may result in unnecessary surgical procedures and inappropriate treatment with a prolonged course of parenteral antibiotics

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