Painful knee prosthesis

Al-Nabhani, Khalsa; Michopoulou, Sofia; Allie, Rayjanah; Alkalbani, Jokha; Saad, Zia; Sajjan, Rakesh; Syed, Rabbani; Bomanji, Jamshed

doi:10.1097/mnm.0000000000000028

Cited by 24 publications

(12 citation statements)

References 22 publications

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“…In addition, previous studies were not able to establish a clear correlation between clinical and radiological outcomes [15, 16, 21, 39, 40]. However, controversial results have been published in recent studies analysing the clinical value of SPECT/CT in patients with knee pain [3, 28, 29, 32]. It is currently still unclear whether BTU shows a significant correlation with clinical outcome parameters in patients with OCL.…”

Section: Discussionmentioning

confidence: 99%

Good clinical results but moderate osseointegration and defect filling of a cell-free multi-layered nano-composite scaffold for treatment of osteochondral lesions of the knee

Mathis

Kaelin

Rasch

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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Section: Discussionmentioning

confidence: 99%

Good clinical results but moderate osseointegration and defect filling of a cell-free multi-layered nano-composite scaffold for treatment of osteochondral lesions of the knee

Mathis

Kaelin

Rasch

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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“…Al-Nabhani [ 40 ] reported on 24 patients with painful knee prostheses who underwent revision surgery. With a medium risk of bias under the QUADAS-2 tool (explained by the flow and timing domain), they achieved a SEN of 0.90 [95% CI: 0.55–1.00] and a SPE of 0.95 [95% CI: 0.86–0.99] for SPECT/CT in identifying the source of pain, ultimately confirming the diagnosis in 21 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Rasch et al [ 47 ] found a significant correlation between valgus alignment of the femoral component and increased BTU in the lateral patellar areas ( P < 0.005). The use of this image scheme was also important for defining particular BTU patterns associated with specific conditions, such as malpositioning of the components, maltracking, patellar overloading, patellar osteoarthritis and loosening, which led the clinician to change the initial diagnosis in up to 85% of the patients [ 40 , 41 , 46 ]. It is important to highlight a recent report by Mathis et al [ 21 ], which showed a significant correlation ( P < 0.05) between different patterns of BTU and the position of the TKA components together with different pain patterns, enhancing the importance of the component position as a potential source of pain in painful knee arthroplasty patients.…”

Section: Discussionmentioning

confidence: 99%

The role of SPECT/CT in painful, noninfected knees after knee arthroplasty: a systematic review and meta-analysis—a diagnostic test accuracy review

Anzola

Hernandez

Rodríguez³

et al. 2023

J Orthop Surg Res

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Purpose The aim of this systematic review was to present the current evidence on the clinical use of single-photon emission computed tomography/computed tomography (SPECT/CT) in the evaluation of noninfected painful knees after knee arthroplasty. Methods Embase, PubMed, Google Scholar, Ovid, Scopus, Science Direct and the Cochrane Database of Systematic Reviews were searched from database inception to May 2022 following the PRISMA guidelines. As a primary outcome, we defined the role of SPECT/CT in the diagnostic approach to noninfected painful knee arthroplasty; as a secondary objective, we described the noninfection-related factors linked to painful knee arthroplasty. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio values and other indicators were calculated; receiver operating characteristic (ROC) curve analysis results and a summary of the areas under the curve (AUCs) from the included studies were reported. A Fagan plot, likelihood ratio plot and Deeks’ funnel plot were generated and analysed. Methodological quality was assessed using the QUADAS-2 tool, and the certainty of evidence was assessed by the GRADE approach. Results A total of 493 publications were identified, of which eight met the inclusion criteria, with a final pooled sample size of 308 patients. The pooled sensitivity and specificity of SPECT/CT in diagnosing the source of pain in painful knee prostheses were 0.86 (95% CI: 0.75–0.93) and 0.90 (95% CI: 0.79–0.96), respectively, with pooled +LR and −LR values of 8.9 (95% CI: 4.11–19.19) and 0.15 (95% CI: 0.09–0.28). The pooled diagnostic odds ratio was 57.35, and the area under the curve was 0.94. SPECT/CT highly accurately identified different sources of pain, such as loosening of the prosthetic components, patellofemoral overloading, instability, malalignment of the components and degeneration of the patellofemoral compartment. The confidence of the estimates was moderate according to the GRADE approach. Conclusion With demonstrated high sensitivity and specificity, as a diagnostic tool, SPECT/CT can identify the source of pain in painful knees after knee arthroplasty, particularly in cases of loosening, patellofemoral disorders and component malalignment (level of evidence III). These findings have significant clinical repercussions, such as in changing the initial diagnosis, identifying or excluding different causes of painful knee arthroplasties, guiding subsequent treatment and positively impacting the final clinical outcome. We moderately recommend the use of SPECT/CT for identifying the source of pain after knee arthroplasty according to the GRADE assessment. This review was preregistered in Prospero under code CRD42022320457.

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“…SPECT/CT showed that patella uptake was associated with treatment response and severity of patellar condral lesions [ 55 ]. Similar to painful hip prosthesis, In patients with painful knee prostheses, SPECT/CT could diagnose accurately infection and prosthesis loosening and had clinical impact on 85.5% of patients [ 56 ].…”

Section: Main Bodymentioning

confidence: 99%

Bone scintigraphy in patients with pain

Shin

Kim

2017

Korean J Pain

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Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disorder of the extremities, which is characterized by sensory, autonomic, vasomotor, and trophic disturbances. To assist the diagnosis of CRPS, three-phase bone scintigraphy is thought to be superior compared to other modalities, and could be used to rule out CRPS due to its high specificity. Studies regarding the effect of bone scintigraphy in patients with extremity pain have not been widely conducted. Ultrasound, CT and MRI are widely used imaging modalities for evaluating extremity pain. However, SPECT/CT has an additional role in assessing pain in the extremities.

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Painful knee prosthesis

Abstract: SPECT/CT is a useful tool for the evaluation of painful knee prosthesis in 85.5% of cases and helps in confirming mechanical loosening and in excluding other causes such as infection and patellofemoral osteoarthritis.

Cited by 24 publications

References 22 publications

Good clinical results but moderate osseointegration and defect filling of a cell-free multi-layered nano-composite scaffold for treatment of osteochondral lesions of the knee

Good clinical results but moderate osseointegration and defect filling of a cell-free multi-layered nano-composite scaffold for treatment of osteochondral lesions of the knee

The role of SPECT/CT in painful, noninfected knees after knee arthroplasty: a systematic review and meta-analysis—a diagnostic test accuracy review

Bone scintigraphy in patients with pain

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