Radionuclide Bone Imaging as a Means of Differentiating Loosening and Infection in Patients with a Painful Total Hip Prosthesis

Abstract

Twenty patients with 23 painful total hip prostheses were examined by radionuclide imaging (20 cases), arthrography (11 cases), needle aspiration (9 cases), and surgery (19 cases) for the purpose of assessing loosening and/or infection. Bone imaging was most accurate, showing three main distributions of activity: (a) ectopic calcification, (b) focal increased activity at the upper and lower ends of the femoral prosthesis, and (c) diffuse activity. These findings suggest that infection and loosening can be differentiated in many instances. None of the patients with focal activity had infection, compared to 2 of the 3 patients with diffuse uptake.

FDG PET for Differentiation of Infection and Aseptic Loosening in Total Hip Replacements: Comparison with Conventional Radiography and Three-Phase Bone Scintigraphy

“…In one patient in our study, the correct diagnosis of infection could only be made with serial radiographs; PET and bone scintigraphy yielded false-negative findings. At bone scintigraphy, focally increased radionuclide uptake around the prosthesis is commonly considered to represent loosening, while diffusely increased uptake is commonly considered to represent infection (36,37). However, infection may also be present in prostheses with focal uptake patterns (24,25).…”

Potential clinical implication of 18F‐FDG PET/CT in diagnosis of periprosthetic infection and its comparison with 18F‐Fluoride PET/CT

“…The diagnostic algorithm of loosened hip prostheses begins with simple serologic blood tests and radiographic studies . These tests have high sensitivity, but they lack the adequate specificity to confirm infection.…”

“…The diagnostic algorithm of loosened hip prostheses begins with simple serologic blood tests and radiographic studies. 29 These tests have high sensitivity, but they lack the adequate specificity to confirm infection. The culture of aspirated joint fluid has high specificity but the aspiration of the hip joint is invasive, technically demanding and require fluoroscopic guidance.…”

Role of Nuclear Medicine in Infection Imaging

“…Williamson and coworkers [16] found that focal periprosthetic uptake was associated with aseptic loosening, whereas diffuse uptake around the femoral and acetabular components was associated with infection.…”