Scintigraphy with Tc, Ga and In in painful total hip prostheses

Gómez-Luzuriaga, M. A.; Galán-Gómez, Víctor; Villar, J. M.

doi:10.1007/bf00266983

Cited by 26 publications

(10 citation statements)

References 16 publications

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“…67 Ga scintigraphy has proven to be a useful addition to bone scintigraphy in patients with painful joint replacements (16). Although the sensitivity of gallium imaging alone is relatively low (17), the accuracy of combined 99m Tc-MDP bone and gallium scintigraphy for detecting joint replacement infection is nearly 80% (18). Controversial results have been reported on the clinical value of 18 F-FDG PET in detecting prosthetic joint infection, usually showing only moderate diagnostic performance (19).…”

Section: Discussionmentioning

confidence: 99%

“…The drug product was verified to be greater than 90% radiochemical purity, as determined by instant thin-layer chromatography (acid citrate and dextrose), in each dose administered. Each 99m Tc-HYNIC-rh-annexin V dose (555-740 MBq [15][16][17][18][19][20]) was administered through an indwelling intravenous line, using the sterile syringe filter (0.22 mm) supplied as part of each 99m Tc-HYNIC-rh-annexin V kit.…”

Section: Study Populationmentioning

confidence: 99%

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The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

Lorberboym¹,

Feldbrin²,

Hendel³

et al. 2009

J Nucl Med

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The aim of this study was to assess the pattern of annexin V uptake in hip and knee prostheses suspected of being infected. Methods: A total of 7 patients undergoing revision surgery for hip or knee prostheses were studied; 5 patients had total hip replacements, and 2 had total knee replacements. Infection was confirmed by pathology, culture results, laboratory evaluation, and clinical follow-up. All patients also underwent a bone scan before surgery. Results: Annexin V scan findings were positive in 5 patients and negative in 2. Annexin V uptake was either focal (n 5 4) or linear (n 5 1). There were 4 true-positive, 2 true-negative, 1 false-positive, and no false-negative annexin V studies. Annexin V uptake was either more extensive or less extensive than, and usually was incongruent with, 99m Tc-methylene diphosphonate uptake. Conclusion: Our findings suggest that annexin V imaging shows greater uptake with infection than with aseptic loosening and has a high negative predictive value for prosthetic infection.Key Words: apoptosis; annexin V; hip; knee; prosthesis; loosening; infection Nucl Med 2009; 50:534-537 DOI: 10.2967/jnumed.108.059345 Asept ic loosening, an event that occurs months to years after surgery, is the most frequent cause of prosthetic joint failure (1). A less common but far more serious source of joint implant loosening is periprosthetic infection with Staphylococcus aureus, methicillin-resistant S. aureus, Staphylococcus epidermidis, Streptococcus oralis, Escherichia coli, Enterococcus faecalis, or Pseudomonas aeruginosa (2). Periprosthetic infections also tend to be low-grade and frequently cannot be detected by blood or tissue culture, leaving little clinical information to guide treating physicians. The differentiation of infection from aseptic loosening is important because loosening caused by a periprosthetic infection requires usually at least a 2-stage revision surgery involving the removal of the old implant, debridement, and placement of antibiotic-loaded cement beads in the surgical bed. This treatment is in contrast to the single-stage prosthetic joint-replacement treatment for aseptic loosening, a completely different process believed to be caused by repeated mechanical stress and local host response to the wear debris of high-density polyethylene, metals, and bone cement (1). JBecause the clinical and laboratory signs of bacterial infection (culture-negative) are nonspecific, standard radiologic and nuclear medicine imaging remain essential first steps for the work-up of patients with painful prostheses (3). Radiographs reveal signs of loosening regardless of the presence or absence of bacterial infection. Although MRI or enhanced CT scans generally provide useful information for soft-tissue and bone infections, metallic artifacts from a given prosthetic device greatly interfere with the quality of the images obtained (4). Nuclear medicine techniques include 99m Tc-methylene diphosphonate ( 99m Tc-MDP) bone scanning, 67 Ga imaging, and 111 In-(or 99m Tc-hexamethylpropyleneam...

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Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

Lorberboym¹,

Feldbrin²,

Hendel³

et al. 2009

J Nucl Med

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“…[7][8][9][10] There are many methods being used for the diagnosis of infected THA. The spe -c i f i c i t y a n d s e n s i t i v i t y i n d e t e c t i n g i n f e c t e d o r t h opedic prosthesis in various scintigraphic studies in the literature are summarized in Table 5.6-8,h1- 16 A positive Tc-99m MDP scan indicates inflammation and possible loosening with high specificity,' but not always infection of the implant.…”

Section: Discussionmentioning

confidence: 99%

The value of Tc-99m Nanocolloid scintigraphy in the evaluation of infected total hip arthroplasties

et al. 1993

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The early diagnosis of loosening is very important, since it provides a chance to protect the bone structure by means of a good postrevision outcome. Although the delayed stage of infected loosenings can easily be detected by clinical presentations, significant laboratory data and plain X-rays, diagnosis becomes a problem in the early stage. In this study the value of Tc-99m Nanocolloid (NCol) scintigraphy in the diagnosis of infected loosenings was evaluated in 28 patients with painful total hip arthroplasty and 10 controls without any complaint after total hip arthroplasty, by comparing this method with laboratory data, plain X-rays and 3-phase Tc-99m methylene diphosphonate (MDP) scintigraphy. Tc-99m NCol scintigraphy was found out to be a very valuable method with 100% sensitivity, 84% specificity in the diagnosis of infected prosthesis and it was superior to laboratory data, plain X-rays and 3-phase Tc-99m MDP scintigraphy, but requires to be evaluated in conjunction with plain X-rays for more information and in order to prevent false positive results.

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“…Tc tutulumundan fazla olduğu durumlar da infeksiyon lehine değerlendirilir. Bu kombinasyonun duyarlılığı-nın daha az olmasına karşın (yaklaşık %70), özgüllüğü önemli oranda yüksektir (yaklaşık %90) (27,29). In-işaretli) ile işaretlenir (29).…”

Section: Görüntüleme Yöntemleriunclassified

“…Bu kombinasyonun duyarlılığı-nın daha az olmasına karşın (yaklaşık %70), özgüllüğü önemli oranda yüksektir (yaklaşık %90) (27,29). In-işaretli) ile işaretlenir (29). Akut osteomyelit tanısında kronik infeksiyona göre çok daha duyarlı ve özgüldür.…”

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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Scintigraphy with Tc, Ga and In in painful total hip prostheses

Cited by 26 publications

References 16 publications

The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

The value of Tc-99m Nanocolloid scintigraphy in the evaluation of infected total hip arthroplasties

Orthopedic Prosthetic Infections

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Scintigraphy with Tc, Ga and In in painful total hip prostheses

Cited by 26 publications

References 16 publications

The Use of 99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

The Use of 99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

The value of Tc-99m Nanocolloid scintigraphy in the evaluation of infected total hip arthroplasties

Orthopedic Prosthetic Infections

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Product

Resources

About

The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses