Evaluation of painful hip arthroplasties. Are technetium bone scans necessary?

Lieberman,; Huo, M. H.; Schneider, Robert J.; Ea, Salvati; Rodi, S

doi:10.1302/0301-620x.75b3.8496226

Cited by 46 publications

(26 citation statements)

References 14 publications

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“…Nonetheless, BS is more sensitive than plain radiographs [20]. Lieberman et al suggested, therefore, that BS is useful only when conventional radiography is inconclusive [21]. Others have suggested that the role of BS should be limited to that of a screening test, or that it should be performed as a part of a combined study with gallium or labelled leucocyte scintigraphy (Table 4).…”

Section: Imaging Techniques and Featuresmentioning

confidence: 99%

Prosthetic joint infections: radionuclide state-of-the-art imaging

Gemmel¹,

Wyngaert²,

Love

et al. 2012

Eur J Nucl Med Mol Imaging

163

151

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Prosthetic joint replacement surgery is performed with increasing frequency. Overall the incidence of prosthetic joint infection (PJI) and subsequently prosthesis revision failure is estimated to be between 1 and 3%. Differentiating infection from aseptic mechanical loosening, which is the most common cause of prosthetic failure, is especially important because of different types of therapeutic management. Despite a thorough patient history, physical examination, multiple diagnostic tests and complex algorithms, differentiating PJI from aseptic loosening remains challenging. Among imaging modalities, radiographs are neither sensitive nor specific and cross-sectional imaging techniques, such as computed tomography and magnetic resonance imaging, are limited by hardware-induced artefacts. Radionuclide imaging reflects functional rather than anatomical changes and is not hampered by the presence of a metallic joint prosthesis. As a result scintigraphy is currently the modality of choice in the investigation of suspected PJI. Unfortunately, there is no true consensus about the gold standard technique since there are several drawbacks and limitations inherent to each modality. Bone scintigraphy (BS) is sensitive for identifying the failed joint replacement, but cannot differentiate between infection and aseptic loosening. Combined bone/gallium scintigraphy (BS/GS) offers modest improvement over BS alone for diagnosing PJI. However, due to a number of drawbacks, BS/GS has generally been superseded by other techniques but it still may have a role in neutropenic patients. Radiolabelled leucocyte scintigraphy remains the gold standard technique for diagnosing neutrophil-mediated processes. It seems to be that combined in vitro labelled leucocyte/bone marrow scintigraphy (LS/BMS), with an accuracy of about 90%, is currently the imaging modality of choice for diagnosing PJI. There are, however, significant limitations using in vitro labelled leucocytes and considerable effort has been devoted to developing alternative radiotracers, such as radiolabelled HIGs, liposomes, antigranulocyte antibodies and fragments, as well as more investigational tracers such as radiolabelled antibiotics, antimicrobial peptides, bacteriophages and thymidine kinase. On the other hand, positron emission tomography (PET) is still growing in the field of PJI imaging with radiotracers such as (18)F-fluorodeoxyglucose (FDG), (18)F-FDG white blood cells and (18)F-fluoride. But unfortunately this superb tomographic technique will only receive full acceptance when specific PET uptake patterns can be successfully developed. The emergence of hybrid modality imaging using integrated single photon emission computed tomography (SPECT) and PET with computed tomography (SPECT/CT and PET/CT) may also have a contributing role for more accurate assessment of joint replacement complications, especially combined with new radiotracers such as (68)Ga and (64)Cu. Finally, in searching for infection-specific tracers, currently there is no such diagnostic agent available.

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Section: Imaging Techniques and Featuresmentioning

confidence: 99%

Prosthetic joint infections: radionuclide state-of-the-art imaging

Gemmel¹,

Wyngaert²,

Love

et al. 2012

Eur J Nucl Med Mol Imaging

163

151

View full text Add to dashboard Cite

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“…These tests have a definite role in the workup of an infected joint arthroplasty, but some lack accuracy and none identify the causative pathogen and its antibiotic sensitivity pattern [1,5,11,17,33,36,40,46,55,57,59,67]. Therefore, aspiration and/or tissue biopsy are used to obtain specimens for additional microbiologic investigation.…”

Section: Introductionmentioning

confidence: 99%

Is There a Role for Tissue Biopsy in the Diagnosis of Periprosthetic Infection?

Meermans

Haddad

2010

Clinical Orthopaedics &Amp; Related Research

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Background Successful treatment of an infected joint arthroplasty depends on correctly identifying the responsible pathogens. The value of a preoperative biopsy remains controversial. Questions/purposes We (1) compared the sensitivity and specificity of both tests separately and in combination, and (2) asked whether the combination of tissue biopsy and aspiration would improve our diagnostic yield in the evaluation of periprosthetic joint infections. Patients and Methods We prospectively followed 120 patients with suspected infection of a total joint arthroplasty: 64 with THAs and 56 with TKAs. All patients had aspiration with culture and biopsy. Results The sensitivity was 83% for aspiration, 79% for biopsy, and 90% for the combination of both techniques. The specificity was 100% for aspiration and biopsy and the combination. The overall accuracy was 84%, 81%, and 90%, respectively.

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“…Fakat böyle bir ayrımı her zaman yapmak kolay olmamakta, infeksiyonların tanısında özgüllüğü oldukça düşük olduğu için, sintigrafinin infeksiyon olmadığı durumlarda eklemin değerlendirilmesinde daha değerli olduğu bildirilmektedir (26,27). Diğer bir problem, asemptomatik hastalarda cerrahi sonrası ilk 12 ay veya daha sonrasında bile kalça eklemi ve femurda %60, dizde %90 aktivite artışı saptanmasıdır.…”

Section: Görüntüleme Yöntemleriunclassified

Orthopedic Prosthetic Infections

Ersöz¹

2015

Klimik Dergisi

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Ortopedik protezlerin yaygın kullanımı nedeniyle bununla ilgili komplikasyonlar karşımıza daha sık çıkmaktadır. Alınan infeksiyon kontrol önlemleri, gelişen cerrahi infeksiyon oranlarını ne kadar azaltsa da protez infeksiyonları halen hem hasta hem de hekim için sıkıntılı bir sürece neden olmaktadır. Bu derlemede, ortopedik protez infeksiyonlarının sıklığı, sıkıntılı tanı süreci ve tedavi yaklaşımlarından ayrıntılı olarak bahsedilmektedir. Mikroorganizmaların yabancı cisme tutunmasını kolaylaştıran ve tedavide başarısızlıklara neden olan biyofilm tabakası patogenezde önemli bir rol oynar. Tanıda henüz bir altın standard olmaması, klinik özelliklerin, görüntüleme ve diğer laboratuvar yöntemlerinin birlikte kullanılmasını gerektirir. En uygun tedavi yaklaşımı hastanın özelliklerine göre belirlenmelidir. Tedavide yaklaşımlar, protez yerinde bırakılarak debridman ve/veya hayat boyu antibiyotik süpresyon tedavisi, tek veya iki aşamalı revizyon ya da çaresiz kalındığı durumlarda implantın çıkarılması, artrodez ve ampütasyondur. Antibiyotik tedavisinde seçilecek ajanlar ve tedavi süreleri tedavide değerlendirilmesi gereken diğer önemli konulardır. Klimik Dergisi 2013; 26(3): 84-93.Anahtar Sözcükler: Osteomyelit, biyofilmler, tedavi, revizyon cerrahisi. AbstractDue to the widespread use of prosthetic orthopedic devices, we more often come across with related complications. Although, surgical infection rates have decreased due to the infection control measures, prosthetic infections still cause distress for both patients and physicians. In this review article the incidence of orthopedic implant infections, troublesome diagnostic processes and treatment approaches are discussed in detail. Biofilm layer on the prosthesis, which facilitates adhesion of the microorganisms to a foreign body part, thereby leading to treatment failure, plays an important role in pathogenesis. Lack of a gold standard for diagnosis necessitates the combined use of clinical features, imaging and other laboratory techniques. Most appropriate treatment approach should be determined according to characteristics of the patient. Treatment approaches are debridement and retention of the prosthesis and/or lifelong suppressive antibiotic therapy, single or two-stage revision, or removal of the implant, arthrodesis or amputation in very desperate cases. Antibiotic agents of choice for treatment and duration of treatment are other important issues that should be considered in the treatment. GirişTıptaki gelişmeler sayesinde insanların yaşam süresi uzamış ve dünyadaki yaşlı popülasyon artmıştır. Doğal olarak ileri yaşta görülen hastalıkların sayısı da önceki yıllara göre artış göstermektedir. Eklem içi protez yerleş-tirilmesi yaşlılıkta gelişen dejeneratif eklem hastalıkları ya da travmalar sonrası eklemlerde hareket ve fonksiyon kayıplarının tedavisinde kullanılan ve eklemin tekrar fonksiyon kazanmasını sağlayan bir tedavi yaklaşımıdır. Günümüzde total veya parsiyel kalça ve diz artroplastileri oldukça sık uygulanan ortopedik cerrahi girişimlerdir. Fakat u...

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Evaluation of painful hip arthroplasties. Are technetium bone scans necessary?

Cited by 46 publications

References 14 publications

Prosthetic joint infections: radionuclide state-of-the-art imaging

Prosthetic joint infections: radionuclide state-of-the-art imaging

Is There a Role for Tissue Biopsy in the Diagnosis of Periprosthetic Infection?

Orthopedic Prosthetic Infections

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