Nuclear Medicine and the Infected Joint Replacement

Love, Charito; Marwin, Scott; Palestro, Christopher J.

doi:10.1053/j.semnuclmed.2008.08.007

Cited by 224 publications

(164 citation statements)

References 45 publications

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“…Radiographs, and to a greater degree CT, can demonstrate periosteal reaction and osteolysis or loosening about one or both components suggestive of infection, but neither are sensitive or specific. Currently, combined leukocyte-marrow imaging is considered the most accurate of radionuclide imaging studies [16] and the gold standard for some periprosthetic infections; however, these techniques have mixed results for shoulder infections [24]. Ultimately, the diagnosis of infection relies on laboratory evaluation of synovial fluid and tissue cultures or frozen-section analysis.…”

Section: Infectionmentioning

confidence: 99%

Magnetic Resonance Imaging of Shoulder Arthroplasty

et al. 2014

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Background: Magnetic resonance (MR) imaging evaluation of the painful failed shoulder arthroplasty is a useful imaging modality due to advancements in metal artifact reduction techniques, which allow assessment of the integrity of the supporting soft-tissue envelope and the implant. Questions/Purposes: The focus of this pictorial review is to illustrate the benefits of MR imaging, whether used alone or as an adjunct to other imaging modalities, in aiding the clinician in the complex decision making process. Methods: A PubMed (MEDLINE) search focusing on the complications and imaging assessment of shoulder arthroplasty was performed. Articles were selected for review based on their pertinence to the aforementioned topics. Results: We discuss the ability of MR imaging to identify why a patient's arthroplasty may have failed. Specific causes including component loosening and implant failure, rotator cuff and deltoid integrity, infection, subtle fractures, and nerve pathology are reviewed, with illustrative sample images. Conclusion: MRI is a valuable tool in the assessment for pathology in the shoulder following arthroplasty.

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Section: Infectionmentioning

confidence: 99%

Magnetic Resonance Imaging of Shoulder Arthroplasty

et al. 2014

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“…Protez enfeksiyonları, ilk cerrahi sonrası %1,5-2,5, revizyon cerrahilerinden sonra ise %20 insidans ile gözlenirler. Mortalite oranları %1-3 civarında olup enfeksiyonun tedavisi maliyeti arttıran nedenlerden biridir (1,4). Ağrıya yönelik tedavi etiyolojiye göre değişecektir.…”

Section: Introductionunclassified

Patient and Personnel Radiation Exposure in Sentinel Lymph Node Practice

Eren¹,

Bekiş²

2017

Nts

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“…Numerous tests and algorithms have been proposed to guide the workup of hip and knee periprosthetic joint infection (PJI) [6,15,16,18]. The American Academy of Orthopaedic Surgeons (AAOS) published a clinical guideline in 2010 to assist in the evaluation of patients for PJI [6,17] and subsequently the Musculoskeletal Infection Society (MSIS) developed a consensus definition for PJI diagnosis in 2011 (Table 1) [21].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Periprosthetic Joint Infection in Medicare Patients: Multicriteria Decision Analysis

Díaz-Ledezma¹,

Lichstein²,

Parvızı³

2014

Clinical Orthopaedics &Amp; Related Research

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Background In the setting of finite healthcare resources, developing cost-efficient strategies for periprosthetic joint infection (PJI) diagnosis is paramount. The current levels of knowledge allow for PJI diagnostic recommendations based on scientific evidence but do not consider the benefits, opportunities, costs, and risks of the different diagnostic alternatives. Questions/purposes We determined the best diagnostic strategy for knee and hip PJI in the ambulatory setting for Medicare patients, utilizing benefits, opportunities, costs, and risks evaluation through multicriteria decision analysis (MCDA). Methods The PJI diagnostic definition supported by the Musculoskeletal Infection Society was employed for the MCDA. Using a preclinical model, we evaluated three diagnostic strategies that can be conducted in a Medicare patient seen in the outpatient clinical setting complaining of a painful TKA or THA. Strategies were (1) screening with serum markers (erythrocyte sedimentation rate [ESR]/ C-reactive protein [CRP]) followed by arthrocentesis in positive cases, (2) immediate arthrocentesis, and (3) serum markers requested simultaneously with arthrocentesis. MCDA was conducted through the analytic hierarchy process, comparing the diagnostic strategies in terms of benefits, opportunities, costs, and risks. Results Strategy 1 was the best alternative to diagnose knee PJI among Medicare patients (normalized value: 0.490), followed by Strategy 3 (normalized value: 0.403) and then Strategy 2 (normalized value: 0.106). The same ranking of alternatives was observed for the hip PJI model (normalized value: 0.487, 0.405, and 0.107, respectively). The sensitivity analysis found this sequence to be robust with respect to benefits, opportunities, and risks. However, if during the decisionmaking process, cost savings was given a priority of higher than 54%, the ranking for the preferred diagnostic strategy changed. Conclusions After considering the benefits, opportunities, costs, and risks of the different available alternatives, our preclinical model supports the American Academy of Orthopaedic Surgeons recommendations regarding the use of serum markers (ESR/CRP) before arthrocentesis as the best diagnostic strategy for PJI among Medicare patients. Level of Evidence Level II, economic and decision analysis. See Instructions to Authors for a complete description of levels of evidence.

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Nuclear Medicine and the Infected Joint Replacement

Cited by 224 publications

References 45 publications

Magnetic Resonance Imaging of Shoulder Arthroplasty

Magnetic Resonance Imaging of Shoulder Arthroplasty

Patient and Personnel Radiation Exposure in Sentinel Lymph Node Practice

Diagnosis of Periprosthetic Joint Infection in Medicare Patients: Multicriteria Decision Analysis

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