Diagnosis Of Aseptic Loosening Research Articles

Diagnostic Performance of Single-Photon Emission Computed Tomography/Computed Tomography in Aseptic Loosening: A Systematic Review and Meta-Analysis.

The aim of this study is to evaluate the diagnostic value and clinical applicability of single-photon emission computed tomography/computed tomography (SPECT/CT) in aseptic loosening (AL) of prostheses by meta-analysis. Literature on the diagnostic value of SPECT/CT in AL of prostheses was obtained by computer and manual review. The quality of the included studies was evaluated according to the Quality Assessment Diagnostic Accuracy Studies 2. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and other indicators were calculated, and a forest map and summary receiver operating characteristic were drawn to calculate the area under the curve. Meta-regression analysis was performed to identify the sources of heterogeneity and corresponding subgroup analysis was performed. A Fagan plot, likelihood ratio point plot, and Deek's funnel plot were drawn and analyzed. A total of 15 studies were included. The meta-analysis results showed that the pooled sensitivity and specificity of SPECT/CT for the diagnosis of aseptic prosthetic loosening were 0.94, 95% confidence interval [CI] (0.90-0.96) and 0.89, 95% CI (0.78-0.95), respectively while the pooled positive likelihood ratio and pooled negative likelihood ratio were 8.65, 95% CI (4.18-17.90) and 0.07, 95% CI (0.04-0.11), respectively. The pooled diagnostic odds ratio was 130.36, 95% CI (45.18-376.19), and the area under the curve was 0.97, 95% CI (0.95-0.98). As a diagnostic method for AL, SPECT/CT has high diagnostic sensitivity and specificity as well as high diagnostic efficiency. It has good clinical application value and should be a primary choice in the diagnosis of AL after joint replacement.

Mid-term follow-up results after implementing a new strategy for the diagnosis and management of periprosthetic joint infections

BackgroundPeriprosthetic joint infections (PJIs) represent one of the most serious complications associated with joint replacement surgeries, a complication also of modern orthopedic surgery despite the efforts that occurred in this field. Frequently PJIs lead to prolonged morbidity, increased costs and mortality.MethodsWe are conducting a single-center observational cohort ongoing study in the Academic Emergency Hospital Sibiu, Romania, study in which sonication of the retrieved and as a rapid method of bacteria detection, molecular identification of bacteria by 16S rRNA beacon-based fluorescent in situ hybridization (bbFISH) are used.ResultsA total of 61 patients were enrolled in this study. The diagnosis of aseptic loosening was established in 30 cases (49.1%) and the diagnosis of periprosthetic joint infection was established at 31 patients (50.8%). The mean follow-up period in the subgroup of patients diagnosed with periprosthetic joint infections was 36.06 ± 12.59 months (range: 1–54). The 25-months Kaplan-Meier survival rate as the end point, as a consequence of the period of enrollment and a different follow-up period for each type of surgical procedure, was 75% after debridement and implant retention, 91.7% after one-stage exchange, 92.3% after two-stage exchange, and 100% after three-stage exchange. There were no significant differences in survival percentage.ConclusionsOur study has good results similar to previously published data. We cannot recommend one strategy of managing prosthetic joint infections over the other. Definitely, there is a need for prospective randomized controlled trials.

Implant Movement Analysis (IMA), A New CT Based Technique for Diagnosis of Aseptic Loosening of Total Knee Arthroplasty

Implant Movement Analysis (IMA), A New CT Based Technique for Diagnosis of Aseptic Loosening of Total Knee Arthroplasty

Can neutrophil-to-lymphocyte, platelet-to-lymphocyte and monocyte-to-lymphocyte ratios be useful to the diagnosis of aseptic loosening after total knee arthroplasty?

The aim of this study is to determine the role of hematological parameters - neutrophil/lymphocyte, platelet/lymphocyte, and monocyte/lymphocyte ratios - in the diagnosis of aseptic loosening after total knee arthroplasty. This study retrospectively analyzed the data of 244 patients who had primary total knee arthroplasty and 66 patients with aseptic loosening developed after total knee arthroplasty. The white blood cell counts, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio and c-reactive protein levels in both groups were determined using the results of venous blood samples collected during preoperative preparation and compared between the groups. Our study findings reveal that the monocyte/lymphocyte ratio of the group with aseptic loosening was statistically significantly different from that of the patient group who had primary total knee arthroplasty (p=0.02). Furthermore, although c-reactive protein levels are not high enough to suggest systemic inflammation, the difference between the groups is statistically significant (p=0.01). No hematological parameter that could be used in the diagnosis of aseptic loosening has been defined in the literature so far. This study demonstrated that the monocyte/lymphocyte ratio could be a helpful parameter in the diagnosis of aseptic loosening (Tab. 1, Fig. 1, Ref. 28).

PMD146 - HEALTH CARE RESOURCE UTILIZATION AND COSTS AMONG PATIENTS WITH ASEPTIC LOOSENING AFTER PRIMARY TOTAL KNEE ARTHROPLASTY

Aseptic loosening (AL) is a common mechanism of failure in patients with primary total knee arthroplasty (TKA). This study compared the health care resource utilization and costs among patients with aseptic loosening (AL) versus those without AL following primary TKA in the United States. This retrospective observational cohort study used Truven MarketScan® Commercial claims database. Patients with diagnosis of AL (index) between 2010 and 2014 and a prior record of TKA with knee osteoarthritis (OA) were identified. The comparison cohort comprised patients without AL diagnosis but a record of TKA with knee OA. Direct and propensity score matching were used to maximize the similarities between the patients with and without AL. The outcomes of interest were rates of inpatient stay, revision TKA, narcotic prescriptions and the total all-cause payments during one-year follow-up from the index. Generalized linear models were used to adjust for the variables not balanced after matching. A total of 2,094 patients (1,047 per cohort) were included after patient matching; mean(SD) age at primary TKA was 54.4 (5.5) years and majority were females (57.4%). Adjusted rates of inpatient stays (80.8% vs 14.7%) and revision TKA (77.0% vs 1.7%) were significantly higher at one-year follow-up (both p<0.0001) in patients with AL compared to patients without AL. The adjusted proportion of patients receiving narcotic prescriptions was nearly 32 percentage points higher in the AL cohort (75.1% vs. 42.8%, p<0.0001). The adjusted mean all-cause payments for patients with AL were nearly four times higher than those for patients without AL ($58,622 vs. $14,201, p<0.0001). After using a doubly robust methodology incorporating both matching and regression, patients with diagnosis of AL following primary TKA had significantly increased healthcare utilization and costs during the one year follow-up than patients without AL in the United States.

The value of 99mTc-MDP bone SPECT/CT in evaluation of patients with painful knee prosthesis.

The purpose of this study was to assess the incremental value of technetium-99m-methyl diphosphonate (Tc-MDP) single-photon emission computed tomography/computed tomography (SPECT/CT) over Tc-MDP two-phase bone scan (TPBS) in the assessment of the patients with pain following knee arthroplasty. Tc-MDP TPBS and Tc-MDP SPECT/CT were performed in 49 patients with knee pain after knee arthroplasty. The scans were reviewed by two readers (nuclear medicine physician and musculoskeletal radiologist). Tc-MDP SPECT/CT studies were interpreted in conjunction with TPBS in this retrospective study to identify the pain generator in painful knee prosthesis. The final diagnosis was established based on a combination of histopathological/cytological findings, other imaging findings (e.g. MRI, radiolabelled white scan), clinical decisions, and management outcomes (including subsequent intraoperative findings). In diagnosing infection or aseptic loosening, a definitive outcome regarding the presence/absence of aseptic loosening or periprosthetic infection was obtained in 41 patients. (a) Sensitivity of Tc-MDP SPECT/CT [100%; 95% confidence interval (CI): 66.4-100%] was higher than Tc-MDP TPBS (88.9%; 95% CI: 51.8-99.7%). (b) Specificity of Tc-MDP SPECT/CT (75%; 95% CI: 53.3-90.2%) was considerably higher than Tc-MDP TPBS (30%; 95% CI: 11.9-54.3%). Alternative diagnoses were identified in 21/49 (43%) patients on Tc-MDP SPECT/CT, which could not be ascertained on Tc-MDP TPBS alone. Tc-MDP SPECT/CT has better sensitivity and specificity compared with Tc-MDP TPBS in diagnosis of aseptic loosening and periprosthestic infection in patients with painful knee arthroplasty. Tc-MDP SPECT/CT identified alternative causes of pain in 43% of patients, which was not identified by Tc-MDP TPBS.

26Postoperative diagnosis and outcome in patients with revision arthroplasty for aseptic loosening.

BackgroundThe most common cause of implant failure is aseptic loosening (AL), followed by prosthetic joint infection (PJI). This study evaluates the incidence of PJI among patients operated with suspected AL and whether the diagnosis of PJI was predictive of subsequent implant failure including re-infection, at 2 years of follow up.MethodsPatients undergoing revision hip or knee arthroplasty due to presumed AL from February 2009 to September 2011 were prospectively evaluated. A sonication fluid of prosthesis and tissue samples for microbiology and histopathology at the time of the surgery were collected. Implant failure include recurrent or persistent infection, reoperation for any reason or need for chronic antibiotic suppression.ResultsOf 198 patients with pre-and intraoperative diagnosis of AL, 24 (12.1 %) had postoperative diagnosis of PJI. After a follow up of 31 months (IQR: 21 to 38 months), 9 (37.5 %) of 24 patients in the PJI group had implant failure compared to only 1 (1.1 %) in the 198 of AL group (p < 0.0001). Sensitivity of sonicate fluid culture (>20 CFU) and peri-prosthetic tissue culture were 87.5 % vs 66.7 %, respectively. Specificities were 100 % for both techniques (95 % CI, 97.9–100 %). A greater number of patients with PJI (79.1 %) had previous partial arthroplasty revisions than those patients in the AL group (56.9 %) (p = 0.04). In addition, 5 (55.5 %) patients with PJI and implant failure had more revision arthroplasties during the first year after the last implant placement than those patients with PJI without implant failure (1 patient; 6.7 %) (RR 3.8; 95 % CI 1.4-10.1; p = 0.015). On the other hand, 6 (25 %) patients finally diagnosed of PJI were initially diagnosed of AL in the first year after primary arthroplasty, whereas it was only 16 (9.2 %) patients in the group of true AL (RR 2.7; 95 % CI 1.2–6.1; p = 0.03).ConclusionsMore than one tenth of patients with suspected AL are misdiagnosed PJI. Positive histology and positive peri-implant tissue and sonicate fluid cultures are highly predictive of implant failure in patients with PJI. Patients with greater number of partial hip revisions for a presumed AL had more risk of PJI. Early loosening is more often caused by hidden PJI than late loosening.

Correlation of Aspiration Results With Aseptic Loosening in Total Hip Arthroplasty

In the evaluation of patients with a persistently painful total hip arthroplasty establishing an accurate diagnosis is paramount in the selection of a successful treatment regimen. It is unknown whether synovial analysis might differentiate aseptic loosening from other causes of failure. A physiological basis exists to suggest that aseptic loosening might be a process of non-segmented leukocytes. The objective of this study was to determine if the synovial fluid differential cell count might aid in the diagnosis of aseptic loosening. A retrospective chart review of all patients who had undergone revision hip arthroplasty with pre-operative or intra-operative aspiration results was performed. Aseptic loosening was defined as gross intraoperative movement in the absence of infection. From these results Relative-Operating Characteristic (ROC) curves were created, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A diagnosis of aseptic loosening was established in 76 of the 253 hips. The ROC curves indicated that lymphocyte count does have utility in the diagnosis of aseptic loosening. If an aspirate has a combination of fewer than 2500 WBCs (sensitivity 93%, specificity 42%, NPV 94%, accuracy 57%) or more than 10% lymphocytes (sensitivity 86%, specificity 42%, NPV 87%, accuracy 55%) then the sensitivity for aseptic loosening is 96%, the specificity is 33%, the NPV is 95% and the accuracy is 52%. In patients with painful total hip arthroplasties in whom infection has been excluded, aspiration data can be a useful adjunct in the diagnosis of aseptic loosening. In aspirates with neither a WBC cell count of less than 2500 nor a lymphocyte cell count of greater than 10% aseptic loosening can be effectively "ruled out" as fewer than 5% of these patients will have aseptic loosening. While non-specific, aspirate differential can be useful to "rule-out" aseptic loosening with a sensitivity and negative predictive value well exceeding that of standard radiographs.

Differentiation of septic and aseptic loosening by PET with both 11C-PK11195 and 18F-FDG in rat models

This study aims to determine the value of PET with C-isoquinoline carboxamide (C-PK11195) and F-fluorodeoxyglucose (F-FDG) in assisting the differentiation of aseptic loosening (AL) from septic loosening (SL) in rat models. Initially, the histological profiles of SL and AL (cellular infiltration and the number of CD68 macrophage and PBR cells) were compared. Subsequently, we investigated whether C-PK11195 alone and also in combination with F-FDG increases the sensitivity and specificity of PET imaging for distinguishing SL from AL. There were distinguishable features between the histological profiles of the SL and AL rat groups. The number of CD68/PBR cells in AL rats was significantly higher than that seen in SL rats (P<0.05). The uptake of C-PK1195 was higher in AL and lower in SL rats. The uptake of F-FDG was higher in SL and lower in AL rats. PET with a C-PK11195 and F-FDG imaging protocol is helpful in the clinical differential diagnosis of AL from SL.

A finite element analysis of the vibration behaviour of a cementless hip system

An early diagnosis of aseptic loosening of a total hip replacement (THR) by plain radiography, scintigraphy or arthography has been shown to be less reliable than using a vibration technique. However, it has been suggested that it may be possible to distinguish between a secure and a loose prosthesis using a vibration technique. In fact, vibration analysis methods have been successfully used to assess dental implant stability, to monitor fracture healing and to measure bone mechanical properties. Several studies have combined the vibration technique with the finite element (FE) method in order to better understand the events involved in the experimental technique. In the present study, the main goal is to simulate the change in the resonance frequency during the osseointegration process of a cementless THR (Zweymüller). The FE method was used and a numerical modal analysis was conducted to obtain the natural frequencies and mode shapes under vibration. The effects were studied of different bone and stem material properties, and different contact conditions at the bone–implant interface. The results were in agreement with previous experimental and computational observations, and differences among the different cases studied were detected. As the osseointegration process at the bone–implant interface evolved, the resonance frequency values of the femur–prosthesis system also increased. In summary, vibration analysis combined with the FE method was able to detect different boundary conditions at the bone–implant interface in cases of both osseointegration and loosening.

Aseptic Loosening of Elbow Prostheses Diagnosed on F-18 FDG PET/CT

Abstract: A 35-year-old woman, having recurrent pain after total elbow arthroplasty, was subjected to positron emission tomography/computed tomography with fluorodeoxyglucose (FDG PET/CT) to rule out infected orthopedic hardware. A diagnosis of aseptic loosening was made based on the gram staining and 9 months of clinical follow-up. This case report highlights the utility of FDG PET/CT in evaluation of painful elbow prostheses and describes the FDG uptake pattern in confirmed case of aseptic loosening.

Use of new biochemical markers in diagnosis of aseptic hip endoprosthesis loosening

Aseptic loosening of endoprosthesis is the most important problem in total hip arthroplasty. The diagnosis of aseptic loosening is based on anamnesis, the clinical findings, the radiography and scintigraphy. Despite the multitude of diagnostic possibilities it is still a problem to get an exact and early diagnosis. The process of loosening in the bone interface always leads to a change of bone structure of the surrounding bone tissue. In a prospective study we measured biochemical markers of bone metabolism in serum and urine to evaluate a possible change occurring parallel to endoprotheic loosening. 37 patients with severe signs of loosening (later intraoperatively confirmed) and 30 patients without any clinical or radiological signs of loosening (control group) were induced. Gender, age and model of endoprosthesis were similar in both groups. Parameters of bone formation (osteocalcin, alkaline phosphatase, procollagen I C-terminal extension peptide) and bone resorption (Cross-linked n-terminal telopetide) were measured. The cross-linked n-terminal telopetide (NTX) was significant increased in the loosening group (p < 0.001). Of the measured bone formation markers only osteocalcin showed a significantly higher level in patients with endoprosthetic loosening (p < 0.002). All other measured parameters of the bone metabolism showed no significant differences between the both groups. Our results show, that biochemical markers can provide relevant information of endoprosthesic loosening. We are now analysing in a prospective longitudinal study whether these parameters are also suitable to detect early endoprosthetic loosening.

Biochemical markers of bone turnover in aseptic loosening in hip arthroplasty

The aim of this study was to determine the diagnostic value of systemic biochemical markers of bone turnover in aseptic loosening in hip arthroplasty, namely the urine levels of three bone resorption peptides - crosslinked n-telopeptides (NTX), c-telopeptides (CTX I) and deoxypyridinoline (DPD). We compared 52 patients with surgically proven component loosening with 52 patients without clinical or radiological signs of endoprosthetic loosening and 52 healthy individuals. All three markers were measured using commercially available enzyme-linked immunoassays. We found significantly increased levels of DPD in the loosening group (p < 0.05), but there was no significant difference between the loosening group and the two reference groups for the other two markers tested. Our data suggest that DPD can be used as an additional tool in the diagnosis of aseptic loosening in hip arthroplasty but CTX I and NTX have no predictive value in this context.

Accuracy of Diagnostic Imaging Techniques in the Diagnosis of Aseptic Loosening of the Femoral Component of a Hip Prosthesis: A Metaanalysis

Accuracy of Diagnostic Imaging Techniques in the Diagnosis of Aseptic Loosening of the Femoral Component of a Hip Prosthesis: A Metaanalysis

Accuracy of Diagnostic Imaging Techniques in the Diagnosis of Aseptic Loosening of the Femoral Component of a Hip Prosthesis: A Meta-analysis

Accuracy of Diagnostic Imaging Techniques in the Diagnosis of Aseptic Loosening of the Femoral Component of a Hip Prosthesis: A Meta-analysis

Harnkonzentrationen von Kollagenabbauprodukten bei Endoprothesenlockerungen

Aseptic loosening is the most common long-term complication in arthroplasty. Loosening is in every case associated with bone resorption at the interface that leads to bone defects and complicates the revision. The diagnosis of aseptic loosening is based on clinical and radiological evaluation. Especially in clinically asymptomatic cases an early diagnosis with these methods is difficult. In our study we wanted to evaluate the diagnostic value of biochemical markers of the bone resorption in aseptic loosening. We compared 58 patients with proven implant loosening during surgery with 67 patients without clinical or radiological signs of loosening. We measured the crosslinks pyridinoline and hydroxypyridinoline in urine samples. In contrast to Schneider et al. [increased urinary crosslink levels in aseptic loosening of total hip arthroplasty, J. Arthroplasty 1995; 13 (6): 687-692] we found no significant differences between loose and asymptomatic hip or knee prosthesis. Also no correlation between the size of the acetabular defects of loose hip implants and the urinary crosslink excretion was measurable. Our results show no or only little diagnostic value of the urinary crosslinks pyridinoline and deoxypyridinoline in aseptic loosening of total hip and knee arthroplasty.

Increased urinary crosslink levels in aseptic loosening of total hip arthroplasty

The diagnosis of aseptic loosening in total hip arthroplasty is predominantly based on clinical and radiographic evaluation. Loosening is usually associated with increased bone resorption at the interface. In this study we wanted to evaluate the diagnostic value of bone markers in aseptic loosening. We compared 50 patients with proven component loosening during surgery with 50 age-, sex-, and implant-matched patients without clinical or radiological signs of loosening. We measured serum markers of bone formation (bone-specific alkaline phosphatase, osteocalcin [OC], procollagen type I propeptides) and bone resorption (collagen n-telopeptide [NTX], deoxypyridinoline [DPYD], pyridinoline [PYD]). We found significantly increased levels of NTX, DPYD, PYD, and OC in the loosening group. The other markers showed no significant difference between both groups. We conclude that determination of urinary crosslinks may offer a new and valuable diagnostic method in the detection of aseptic loosening in total hip arthroplasty.

Efficacy of intraoperative cultures obtained during revision total hip arthroplasty

The purpose of this study was to determine the incidence of positive intraoperative cultures, correlate the findings of the permanent histopathology with the results of culture, and determine the natural history and predictive value of the positive intraoperative culture in a consecutive series of 138 revision total hip arthroplasties. The incidence of positive cultures was 30% (42 hips). Of these 42 hips, only 1 ultimately developed sepsis, requiring a second surgical procedure. After a mean follow-up period of 48 months, the remaining 41 culture-positive hips show no evidence of sepsis and are considered clinical successes. The histologic appearance of the infected case was characterized by polymorphonuclear leukocyte infiltration suggestive of acute inflammation. The remaining hips demonstrated findings of chronic inflammation consistent with a diagnosis of aseptic loosening. With the development of sepsis as an endpoint, the positive predictive value of a positive intraoperative culture is 2.4%. The results demonstrate that intraoperative cultures are an unreliable predictor of sepsis and that permanent histologic sectioning is a more useful tool in determining sepsis at the time of revision surgery.

Loosening of total hip arthroplasty. Diagnosis by vibration analysis

The early diagnosis of aseptic loosening of a total hip replacement by plain radiography, scintigraphy and arthrography has been shown to be unreliable. It has been suggested that it may be possible to distinguish between a secure and a loose prosthesis using a vibration technique. We have assessed the use of this technique in vitro using models of early and late loosening. Late loosening with an unstable prosthesis can be reliably detected by vibration analysis, but this method was shown to have a very poor diagnostic sensitivity in early loosening when there is no obvious prosthetic instability.