White blood cell scintigraphy for differentiation of infection and aseptic loosening: A retrospective study of 76 painful hip prostheses

Simonsen, Lene; Buhl, Anna; Oersnes, Thue; Duus, Benn R

doi:10.1080/17453670710014338

Cited by 30 publications

(17 citation statements)

References 39 publications

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“…Our results (Table 5) confirmed the reputation of high sensitivity and low specificity of this technique [30, 31, 42, 43]. Unfortunately, subgroup analysis of imaging time after implantation could not be performed owing to insufficient data.…”

Section: Discussionsupporting

confidence: 78%

What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis

Verberne

Sonnega

Temmerman

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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BackgroundIn the assessment of possible periprosthetic knee infection, various imaging modalities are used without consensus regarding the most accurate technique.Questions/PurposesTo perform a meta-analysis to compare the accuracy of various applied imaging modalities in the assessment of periprosthetic knee infection.MethodsA systematic review and meta-analysis was conducted with a comprehensive search of MEDLINE and Embase® in accordance with the PRISMA and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) recommendations to identify clinical studies in which periprosthetic knee infection was investigated with different imaging modalities. The sensitivity and specificity of each imaging technique were determined and compared with the results of microbiologic and histologic analyses, intraoperative findings, and clinical followup of more than 6 months. A total of 23 studies, published between 1990 and 2015, were included for meta-analysis, representing 1027 diagnostic images of symptomatic knee prostheses. Quality of the included studies showed low concerns regarding external validity, whereas internal validity indicated more concerns regarding the risk of bias. The most important concerns were found in the lack of uniform criteria for the diagnosis of a periprosthetic infection and the flow and timing of the included studies. Differences among techniques were tested at a probability less than 0.05 level. Where there was slight overlap of confidence intervals for two means, it is possible for the point estimates to be statistically different from one another at a probability less than 0.05. The z-test was used to statistically analyze differences in these situations.ResultsBone scintigraphy was less specific than all other modalities tested (56%; 95% CI, 0.47–0.64; p < 0.001), and leukocyte scintigraphy (77%; 95% CI, 0.69–0.85) was less specific than antigranulocyte scintigraphy (95%; 95% CI, 0.88–0.98; p < 0.001) or combined leukocyte and bone marrow scintigraphy (93%; 95% CI, 0.86–0.97; p < 0.001). Fluorodeoxyglucose positron emission tomography (FDG-PET) (84%; 95% CI, 0.76–0.90) was more specific than bone scintigraphy (56%; 95% CI, 0.47–0.64; p < 0.001), and less specific than antigranulocyte scintigraphy (95%; 95% CI, 0.88–0.98; p = 0.02) and combined leukocyte and bone marrow scintigraphy (93%; 95% CI, 0.86–0.97; p < 0.001). Leukocyte scintigraphy (88%; 95% CI, 0.81–0.93; p = 0.01) and antigranulocyte scintigraphy (90%; 95% CI, 0.78–0.96; p = 0.02) were more sensitive than FGD-PET (70%; 95% CI, 0.56–0.81). However, because of broad overlapping of confidence intervals, no differences in sensitivity were observed among the other modalities, including combined bone scintigraphy (93%; 95% CI, 0.85–0.98) or combined leukocyte and bone marrow scintigraphy (80%; 95% CI, 0.66–0.91; p > 0.05 for all paired comparisons).ConclusionsBased on current evidence, antigranulocyte scintigraphy and combined leukocyte and bone marrow scintigraphy appear to be highly specific imaging modalities in confirming peripr...

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Section: Discussionsupporting

confidence: 78%

What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis

Verberne

Sonnega

Temmerman

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Bone scintigraphy is known to have a limited value within the first year after TKA owing to physiological biologic processes surrounding the prosthesis. In consequence, it shows positive results in asymptomatic patients [14,15]. Even two years after primary TKA, bone scintigraphy has reportedly shown an increased signal in 12.5% of asymptomatic patients [16].…”

Section: Discussionmentioning

confidence: 97%

“…Simonsen et al described a sensitivity of 0.81 and a specificity of 0.94 in detecting septic complications after total hip arthroplasty in leukocyte scintigraphy [15]. The combination of bone scintigraphy with leukocyte scintigraphy is reported to lead to more accurate diagnoses [9,15].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of bone scintigraphy for aseptic loosening after total knee arthroplasty

Claaßen

Ettinger

Plaaß

et al. 2014

THC

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BACKGROUND: Despite technical improvements, aseptic loosening after total knee arthroplasty (TKA) remains a frequent complication. A one-stage revision arthroplasty is the most common therapeutic pathway. OBJECTIVE: The aim of this study was to evaluate the diagnostic value of bone scintigraphy in detecting aseptic loosening after TKA. METHODS: We retrospectively identified 46 cases of one-stage revision TKA performed between January 2011 and December 2012. In each case a bone scintigraphy was performed at least one year after the primary TKA and 3.2 ± 2.2 month prior to revision arthroplasty. Additionally, we evaluated the rate of satisfaction and pain level 16.2 ± 5.4 months after one-stage revision arthroplasty. RESULTS: Bone scintigraphy indicated aseptic loosening in 28 cases. Intraoperative aseptic loosening was verified in 34 cases. Bone scintigraphy had a sensitivity of 0.76 and a specificity of 0.83 in detecting aseptic loosening. The positive predictive value was 0.93, and the negative predictive value 0.56. At follow-up consultation, 35 patients were very satisfied or satisfied, and 31 patients had no pain or occasional pain. CONCLUSIONS: Bone scintigraphy is a helpful tool in detecting aseptic loosening after TKA. Nevertheless, the results from bone scintigraphy should be compared with clinical findings and patients' disorders. Level of evidence: IV, retrospective study

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“…This is consistent with similar studies using 99m Tchexamethylpropylene amine oxime ( 99m Tc-HMPAO)-labelled granulocytes or 111 In-oxinelabelled granulocytes for imaging infection of suspected prosthesis loosening. 29 Love et al 30 showed that labelled leucocytes accumulate not only in infected areas but also in the bone marrow. Historically, haematopoietically active marrow in adults has been assumed to be limited to the axial skeleton and proximal appendicular skeleton, with any labelled leucocyte activity outside this distribution ascribed to infection.…”

Section: Discussionmentioning

confidence: 99%

^99mTc-Fab' Fragments (Sulesomab) for Imaging Septically Loosened Total Knee Arthroplasty

Gratz

Behr

Reize³

et al. 2009

J Int Med Res

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The diagnostic accuracy of infection scintigraphy with 99m Tc-labelled monoclonal antibody Fab′ fragments (sulesomab) was studied in patients with suspected total knee arthroplasty (TKA) infection. Images from 26 patients were evaluated by two independent readers and compared with a quantitative interpretation of time-activity courses. Microbiological examinations and joint aspiration results were used as reference standards. Histologically, aseptic TKA loosening occurred in two patients and severe, moderate or mild septic loosening in four, nine and 11 patients, respectively. Diagnostic accuracy for severe infection was 100% for both readers, whereas for moderate infection accuracy decreased by 12% and 12% for readers one and two, respectively. For mild infection a further decrease of approximately 61% and 52% occurred for readers one and two, respectively. Quantitative evaluation gave significantly better results over visual interpretation with a diagnostic accuracy of 100% for severe infection and decreased by only 10% and 15% in patients with moderate and mild infection, respectively. Quantitative evaluation of 99m Tc-Fab′ fragments is highly sensitive and specific for diagnostic imaging of infection in patients with septically-loosened TKA.

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White blood cell scintigraphy for differentiation of infection and aseptic loosening: A retrospective study of 76 painful hip prostheses

Abstract: White blood cell scintigraphy with additional late imaging is an effective tool for differentiation between loosening and infection in painful hip arthroplasty.

Cited by 30 publications

References 39 publications

What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis

What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis

Diagnostic value of bone scintigraphy for aseptic loosening after total knee arthroplasty

^99mTc-Fab' Fragments (Sulesomab) for Imaging Septically Loosened Total Knee Arthroplasty

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