Three-phase bone scintigraphy pattern of loosening in uncemented hip prostheses

Abstract

The three-phase bone scintigraphy pattern of loosening in uncemented hip prostheses (UHPs) has not previously been elucidated. We evaluated 28 patients with complicated UHPs who had undergone total hip arthroplasty a very long time previously (range 3-20 years, mean 8.4). All the patients were surgically reviewed: 26 UHPs were found to be loosened and two infected. Nine asymptomatic UHPs were taken as controls. The dynamic phase was invariably negative in both loosened and asymptomatic UHPs while markedly positive in the infected ones. The blood pool phase was positive to various degrees in 16 of the 26 loosened UHPs as well as in the infected UHPs, but was invariably negative in painless replacements. In the bone phase, areas of significantly (discrete to marked) increased uptake were observed in all the loosened prostheses as well as in two-thirds of the asymptomatic ones. However, the regions of the lesser trochanter and/or tip and/or shaft were involved exclusively in the case of the loosened UHPs, and diffuse periprosthetic uptake was found only with loosened or infected implants. Areas of slight methylene diphosphonate (MDP) uptake were found at every periprosthetic site and areas of discrete to marked MDP uptake were commonly found in the acetabulum and/or the greater trochanter with both loosened and painless prostheses and are thus considered to be nonspecific findings.

Diagnosis of peri-prosthetic infection at the hip using triple-phase bone scintigraphy

“…2 In this setting, the sensitivity was reported as 94% and specificity was 95%, when positive results during the blood flow, blood pool and late phase were interpreted as indicative of infection. 2 Rubello et al 10 reported 100% sensitivity and specificity for triple-phase bone scintigraphy in two patients with prosthetic implants, and Reinartz et al 11 found that the sensitivity and specificity of triple-phase bone scintigraphy was 68% and 76%, respectively, in a series of eight patients with peri-prosthetic infection. However, in these reports, the authors defined infection as showing positive results for the blood pool and late phases only.…”

“…Positron-emission tomography has been used for the differential diagnosis of a painful THR. 10 Although it has proven useful in diagnosing malignant tumours, it is not thought to be sensitive enough to distinguish between infected and non-infected implants. 13,14 Furthermore, it is expensive and remains limited to a few institutions, whereas triple-phase bone scintigraphy is widely available and inexpensive.…”

A comparative study on medium-term results of cementless acetabular components with metal-on-metal and metal-on-polyethylene articulations

“…Acetabular radiolucent lines and osteolysis were measured using the zones described by DeLee and Charnley [7]. With this method, an increased uptake in blood pool and bone phase suggests possible loosening of the cup [9]. Heterotopic ossification was assessed using the classification of Brooker et al [8].…”

Radiographically Occult Latent Radiogenic Osteosarcoma Uncovered on Tc-99m Methylene-diphosphonate Bone Scintigraphy

“…[ 4 ] However these findings in combination with the bone scan findings, provided enough suspicion of a pathology sinister enough to refer the patient for surgical hardware revision with potential biopsy. [ 5 6 ]…”