Diagnostic Accuracy of SPECT/CT Arthrography in Patients With Suspected Aseptic Joint Prosthesis Loosening

Abstract Purpose To evaluate the diagnostic accuracy of SPECT/CT arthrography in patients with suspected aseptic prosthesis loosening following hip and knee arthroplasty. Methods A retrospective review of 63 SPECT/CT arthrogram studies (36 knees and 27 hips) between February 1, 2013 and July 1, 2018 was conducted. All patients underwent clinical and radiologic evaluation as part of their assessment for persistent pain following hip and knee arthroplasty. The detection of tracer activity along the bone-prosthetic interface on SPECT/CT suggests aseptic loosening. Operative assessment as well as clinical/ radiologic follow-up at a minimum of one year were used as the reference standard. Results The sensitivity and specificity of SPECT/CT for detection of aseptic loosening was 6/7 (86%) and 55/56 (98%) respectively. This gives a positive predictive value (PPV) of 6/7 (86%), a negative predictive value (NPV) of 55/56 (98%), and a diagnostic accuracy of 61/63 (97%). Conclusion SPECT/CT arthrography has a high diagnostic accuracy (97%) in the evaluation of loosening of both hip and knee arthroplasties in patients with persistent post-procedural pain.

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Diagnostic Accuracy Of Spect/CT Arthrography In Patients With Suspected Aseptic Joint Prostheses Loosening

10.21203/rs.3.rs-126046/v2 ◽

2021 ◽

Author(s):

Bo Bao ◽

Crystal Sixian Liu ◽

Edward C.O Masson ◽

Jonathan Abele

Keyword(s):

Diagnostic Accuracy ◽

Aseptic Loosening ◽

Knee Arthroplasty ◽

Predictive Value ◽

Prosthesis Loosening ◽

Ct Arthrography ◽

Radiologic Evaluation ◽

Aseptic Prosthesis Loosening ◽

Hip And Knee Arthroplasty ◽

Joint Prostheses

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Diagnostic accuracy of SPECT/CT arthrography in patients with suspected aseptic joint prostheses loosening

European Journal of Hybrid Imaging ◽

10.1186/s41824-021-00098-y ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Bo Bao ◽

Crystal S. Liu ◽

Edward C. O. Masson ◽

Jonathan T. Abele

Keyword(s):

Diagnostic Accuracy ◽

Aseptic Loosening ◽

Knee Arthroplasty ◽

Predictive Value ◽

Prosthesis Loosening ◽

Ct Arthrography ◽

Radiologic Evaluation ◽

Aseptic Prosthesis Loosening ◽

Hip And Knee Arthroplasty ◽

Joint Prostheses

Abstract Purpose To evaluate the diagnostic accuracy of SPECT/CT arthrography in patients with suspected aseptic prosthesis loosening following hip and knee arthroplasty. Methods A retrospective review of 63 SPECT/CT arthrogram studies (36 knees and 27 hips) between February 1, 2013, and July 1, 2018, was conducted. All patients underwent clinical and radiologic evaluation as part of their assessment for persistent pain following hip and knee arthroplasty. The detection of tracer activity along the bone-prosthetic interface on SPECT/CT suggests aseptic loosening. Operative assessment as well as clinical/radiologic follow-up at a minimum of 1 year was used as the reference standard. Results The sensitivity and specificity of SPECT/CT for detection of aseptic loosening was 6/7 (86%) and 55/56 (98%), respectively. This gives a positive predictive value (PPV) of 6/7 (86%), a negative predictive value (NPV) of 55/56 (98%), and a diagnostic accuracy of 61/63 (97%). Conclusion SPECT/CT arthrography has a high diagnostic accuracy (97%) in the evaluation of loosening of both hip and knee arthroplasties in patients with persistent post-procedural pain.

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Predictive Value of the Risk Assessment and Prediction Tool (RAPT) Score for Primary Hip and Knee Arthroplasty Patients: A Single-Center Study

Cureus ◽

10.7759/cureus.14112 ◽

2021 ◽

Author(s):

Awf A Alshahwani ◽

Maurice Dungey ◽

Christopher Lillie ◽

Steve Krikler ◽

Christos Plakogiannis

Keyword(s):

Risk Assessment ◽

Knee Arthroplasty ◽

Predictive Value ◽

Prediction Tool ◽

Single Center ◽

Single Center Study ◽

Hip And Knee Arthroplasty ◽

Center Study

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Blood and synovial fluid calprotectin as biomarkers to diagnose chronic hip and knee periprosthetic joint infections

The Bone & Joint Journal ◽

10.1302/0301-620x.103b1.bjj-2020-0953.r1 ◽

2021 ◽

Vol 103-B (1) ◽

pp. 46-55

Author(s):

Dariusz Grzelecki ◽

Piotr Walczak ◽

Marta Szostek ◽

Aleksandra Grajek ◽

Stanisław Rak ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Synovial Fluid ◽

Knee Arthroplasty ◽

Predictive Value ◽

Joint Infection ◽

Total Hip ◽

Joint Infections ◽

Hip And Knee Arthroplasty ◽

Aseptic Revision ◽

Strip Test

Aims Calprotectin (CLP) is produced in neutrophils and monocytes and released into body fluids as a result of inflammation or infection. The aim of this study was to evaluate the utility of blood and synovial CLP in the diagnosis of chronic periprosthetic joint infection (PJI). Methods Blood and synovial fluid samples were collected prospectively from 195 patients undergoing primary or revision hip and knee arthroplasty. Patients were divided into five groups: 1) primary total hip and knee arthroplasty performed due to idiopathic osteoarthritis (OA; n = 60); 2) revision hip and knee arthroplasty performed due to aseptic failure of the implant (AR-TJR; n = 40); 3) patients with a confirmed diagnosis of chronic PJI awaiting surgery (n = 45); 4) patients who have finished the first stage of the PJI treatment with the use of cemented spacer and were qualified for replantation procedure (SR-TJR; n = 25), and 5) patients with rheumatoid arthritis undergoing primary total hip and knee arthroplasty (RA; n = 25). CLP concentrations were measured quantitatively in the blood and synovial fluid using an immunoturbidimetric assay. Additionally, blood and synovial CRP, blood interleukin-6 (IL-6), and ESR were measured, and a leucocyte esterase (LE) strip test was performed. Results Patients with PJI had higher CLP concentrations than those undergoing aseptic revision in blood (median PJI 2.14 mg/l (interquartile range (IQR) 1.37 to 3.56) vs AR-TJR 0.66 mg/l (IQR 0.3 to 0.83); p < 0.001) and synovial fluid samples (median PJI 20.46 mg/l (IQR 14.3 to 22.36) vs AR-TJR 0.7 mg/l (IQR 0.41 to 0.95); p < 0.001). With a cut-off value of 1.0 mg/l, blood CLP showed a sensitivity, specificity, positive predictive value, and negative predictive value of 93.3%, 87.5%, 89.4%, and 92.1%, respectively. For synovial fluid with a cut-off value of 1.5 mg/l, these were 95.6%, 95%, 95.5%, and 95%, respectively. Conclusion This small study suggests that synovial and blood CLP are useful markers in chronic PJI diagnosis with similar or higher sensitivity and specificity than routinely used markers such as CRP, ESR, IL-6, and LE. CLP was not useful to differentiate patients with PJI from those with rheumatoid arthritis. Cite this article: Bone Joint J 2021;103-B(1):46–55.

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Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty

The Open Orthopaedics Journal ◽

10.2174/1874325001610010241 ◽

2016 ◽

Vol 10 (1) ◽

pp. 241-251 ◽

Cited By ~ 24

Author(s):

Erhan Sukur ◽

Yunus Emre Akman ◽

Yusuf Ozturkmen ◽

Fatih Kucukdurmaz

Keyword(s):

Aseptic Loosening ◽

Hip Arthroplasty ◽

Inflammatory Responses ◽

Therapeutic Interventions ◽

Wear Particles ◽

Biological Mechanisms ◽

Prosthesis Loosening ◽

Periprosthetic Osteolysis ◽

Aseptic Prosthesis Loosening

Background:Inflammatory responses to wear debris cause osteolysis that leads to aseptic prosthesis loosening and hip arthroplasty failure. Although osteolysis is usually associated with aseptic loosening, it is rarely seen around stable implants. Aseptic implant loosening is a simple radiologic phenomenon, but a complex immunological process. Particulate debris produced by implants most commonly causes osteolysis, and this is called particle-associated periprosthetic osteolysis (PPO).Objective:The objective of this review is to outline the features of particle-associated periprosthetic osteolysis to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome.Methods:A thorough literature search was performed using available databases, including Pubmed, to cover important research published covering particle-associated PPO.Results:Although osteolysis causes bone resorption, clinical, animal, andin vitrostudies of particle bioreactivity suggest that particle-associated PPO represents the culmination of several biological reactions of many cell types, rather than being caused solely by the osteoclasts. The biological activity is highly dependent on the characteristics and quantity of the wear particles.Conclusion:Despite advances in total hip arthroplasty (THA), particle-associated PPO and aseptic loosening continue to be major factors that affect prosthetic joint longevity. Biomarkers could be exploited as easy and objective diagnostic and prognostic targets that would enable testing for osteolysis after THA. Further research is needed to identify new biomarkers in PPO. A comprehensive understanding of the underlying biological mechanisms is crucial for developing new therapeutic interventions to reverse or suppress biological responses to wear particles.

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Plasma D-Dimer as a Marker for Postoperative Deep Venous Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648938 ◽

1994 ◽

Vol 72 (05) ◽

pp. 663-665 ◽

Cited By ~ 29

Author(s):

Irene D Dunn ◽

Anthony C W Hui ◽

Paul D Triffitt ◽

Ann E C Crozier ◽

Paul J Gregg ◽

...

Keyword(s):

Positive Predictive Value ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Knee Arthroplasty ◽

Predictive Value ◽

Hip And Knee Arthroplasty ◽

Relationship Of ◽

The Relationship ◽

Postoperative Deep Venous Thrombosis ◽

D Dimer

SummaryPlasma levels of D-dimer have been found useful as a marker of deep venous thrombosis in those patients in whom thrombosis is suspected, but their usefulness in postoperative screening is less clear. We have investigated the relationship of D-dimer to deep venous thrombosis in 90 patients after total hip and knee arthroplasty. From the first postoperative day the D-dimer levels were found to be highly significantly raised in patients with deep venous thrombosis. A combined result over the first six postoperative days in excess of 1200ng/ml correlated with thrombosis with a specificity of 100%, sensitivity of 45%, positive predictive value of 60%, and negative predictive value of 100%. However, individual estimations were not discriminatory.

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The Diagnostic Accuracy of Radionuclide Arthrography for Prosthetic Loosening in Hip and Knee Arthroplasty

BioMed Research International ◽

10.1155/2013/693436 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Timothy H. French ◽

Nicholas Russell ◽

Anand Pillai

Keyword(s):

Knee Arthroplasty ◽

Predictive Value ◽

Diagnostic Tools ◽

Total Knee Replacements ◽

Knee Replacements ◽

Hip Replacements ◽

Hip And Knee Arthroplasty ◽

Prosthetic Loosening ◽

Total Knee ◽

Mean Time

Purpose of Study. Diagnosis of prosthetic loosening in hip and knee arthroplasty remains a challenge. Although there are a number of diagnostic tools, no single test or combination is 100% sensitive or specific. There has been a recent interest in the use of radionuclide arthrography (RNA) for detection of prosthetic loosening.Methods. A retrospective review of 45 consecutive RNA scans from 2005 to 2010 was conducted. RNA findings were compared with intraoperative findings at revision and/or serial radiographic examinations to confirm loosening. A component was considered loose if sequential radiographs demonstrated macromotion, gross subsidence, or progressive radiolucency.Results. There were 26 females and 17 males, with mean age at RNA of 71 years (range of 53–89 years) and mean time from index surgery, 6.4 years (range of 0.5–23 years). There were 23 total knee replacements (TKR) (19 primary and 4 revision) and 20 total hip replacements (THR) (11 primary and 9 revision). 15 patients underwent revision surgery following RNA. Strict inclusion criteria allowed 27 patients for further analysis. Sixteen RNA scans were suggestive of loosening, of which 14 were confirmed loose. Eleven scans were suggestive of a stable prosthesis, of which 10 were confirmed well fixed. RNA had a sensitivity of 93%, specificity of 83%, positive predictive value of 88%, and negative predictive value of 91%.Conclusion. Radionuclide arthrography should be considered a useful adjunct in the diagnosis of prosthetic loosening in the challenging patient.

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Noninvasive Evaluation of Coronary Artery Bypass Grafts with 16-Slice Multidetector Computed Tomography

The Heart Surgery Forum ◽

10.1532/hsf98.20111075 ◽

2012 ◽

Vol 15 (1) ◽

pp. 12 ◽

Cited By ~ 1

Author(s):

Levent Sahiner ◽

Ali Oto ◽

Kudret Aytemir ◽

Tuncay Hazirolan ◽

Musturay Karcaaltincaba ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Diagnostic Accuracy ◽

Multidetector Computed Tomography ◽

Coronary Artery Bypass ◽

Predictive Value ◽

Artery Bypass ◽

Time Interval ◽

Mdct Angiography ◽

Sensitivity Specificity

Background: The aim of this study was to investigate the diagnostic accuracy of 16-slice multislice, multidetector computed tomography (MDCT) angiography for the evaluation of grafts in patients with coronary artery bypass grafting (CABG).Methods: Fifty-eight consecutive patients with CABG who underwent both MDCT and conventional invasive coronary angiography were included. The median time interval between the 2 procedures was 10 days (range, 1-32 days). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT for the detection of occluded grafts were calculated. The accuracy of MDCT angiography for detecting significant stenoses in patent grafts and the evaluability of proximal and distal anastomoses were also investigated.Results: Optimal diagnostic images could not be obtained for only 3 (2%) of 153 grafts. Evaluation of the remaining 150 grafts revealed values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the MDCT angiography procedure for the diagnosis of occluded grafts of 87%, 97%, 94%, 93%, and 92%, respectively. All of the proximal anastomoses were optimally visualized. In 4 (8%) of 50 patent arterial grafts, however, the distal anastomotic region could not be evaluated because of motion and surgical-clip artifacts. The accuracy of MDCT angiography for the detection of significant stenotic lesions was relatively low (the sensitivity, specificity, PPV, and NPV were 67%, 98%, 50%, and 99%, respectively). The number of significant lesions was insufficient to reach a reliable conclusion, however.Conclusion: Our study showed that MDCT angiography with 16-slice systems has acceptable diagnostic performance for the evaluation of coronary artery bypass graft patency.

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