Comparison of subtraction arthrography, radionuclide arthrography and conventional plain radiography to assess loosening of total knee arthroplasty / Vergleich von Subtraktionsarthrographie, Radionuklidarthrographie und konventionellem Röntgen zur Erfassung von Prothesenlockerungen in der Knierevisionschirurgie

Abstract

The value of plain radiographs, digital subtraction arthrography and radionuclide arthrography was analysed in 23 cases of failed total knee arthroplasty. The preoperative diagnosis was compared with the intraoperative assessment. Sensitivity, specificity and the positive and negative predictive value for assessing a loose component were determined separately for the femoral and tibial components. At revision we found 13 loose femoral and 12 loose tibial implants. In eight cases both components were unstable. Plain radiography had a sensitivity of 77% for loosening of the femoral and 83% for the tibial component; digital subtraction arthrography 77% for the femoral and 8% for the tibial component and radionuclide arthrography 31% and 8%. The specificity for plain radiography was 90% for the femoral and 72% for the tibial implant. For subtraction arthrography it was 50% and 82% and for subtraction arthrography 70% and 82%. Radiography had the highest positive and negative predictive values for both components compared with the other two techniques. As a diagnostic tool to detect implant loosening, plain radiography is the most effective in this study. Subtraction arthrography and radionuclide arthrography are not suitable for use as routine methods for detection of total knee arthroplasty loosening.

MRI and SPECT/CT demonstrate, with low certainty of evidence, the highest diagnostic accuracy for aseptic knee arthroplasty loosening: A systematic comparative diagnostic test review and meta‐analysis

“…We identified 467 articles, including 14 in our analysis (Figure 1) [1, 2, 6, 7, 10, 14, 18, 21–23, 25, 30, 35, 37]. None of the included articles reported accuracy metrics for CT with or without contrast.…”

“…Claassen et al and Smith et al retrospectively identified 46 and 71 cases of aseptic TKA loosening, respectively, using bone scintigraphy [7, 35]. Kitchener et al evaluated radionuclide arthrograms of 66 cases with suspected aseptic loosening, while Marx et al retrospectively assessed 23 cases with radionuclide arthrogram [18, 22].…”

Peri-Implant Distribution of Polyethylene Debris in Postmortem-Retrieved Knee Arthroplasties: Can Polyethylene Debris Explain Loss of Cement-Bone Interlock in Successful Total Knee Arthroplasties?

“…Plain radiographs were used to determine the degree of radiographic loosening at time of death according to standard technique [19, 20] and were scored by a board certified orthopaedic surgeon with extensive experience performing TKAs (BLINDED). Five components were rated “well-fixed” with incomplete radiolucency of <2 mm thickness around the implant at the cement-bone interface.…”

The Distribution of Implant Fixation for Femoral Components of TKA: A Postmortem Retrieval Study

“…Donor age, weight, height, time in service and BMI were documented (Table 1). Plain radiographs of the TKA retrievals were reviewed and classified according to standard radiographic techniques of assessment for loosening [13, 14]. …”