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Bone imaging after total replacement arthroplasty of the hip joint. A follow-up with different radiopharmaceuticals
Insights
Bone imaging using 99mTc-HEDP and 18F can predict late hip replacement infections early. While 18F imaging is more accurate, both methods show potential for diagnosing complications after hip arthroplasty.
Area of Science:
- Orthopedics
- Nuclear Medicine
- Radiology
Background:
- Total hip replacement arthroplasty is a common procedure.
- Late complications, such as infection, can significantly impact patient outcomes.
- Early diagnosis of these complications is crucial for effective management.
Purpose of the Study:
- To evaluate the efficacy of bone imaging with 99mTc-HEDP and 18F in detecting late infections after total hip replacement.
- To compare the diagnostic accuracy of 99mTc-HEDP and 18F in identifying postoperative complications.
Main Methods:
- Bone imaging was performed every three months in patients post-total hip replacement.
- Uptake ratios were calculated using 99mTc-HEDP and 18F over the prosthesis and surrounding tissues.
- Radiological evidence and clinical follow-up were used to assess diagnostic accuracy.
Main Results:
- Uptake ratios rapidly declined postoperatively, stabilizing at 6-9 months.
- Eight cases of late infection were correctly predicted 1-3 months prior to radiological signs.
- 18F imaging demonstrated higher accuracy than 99mTc-HEDP, with false positives mainly due to soft tissue inflammation.
Conclusions:
- Bone imaging, particularly with 18F, shows potential for early diagnosis of late complications after hip arthroplasty.
- The clinical significance is limited by the low rate of conservative treatment for diagnosed infections.
- Bone imaging is recommended to exclude late infection as a cause of pain post-hip replacement.
Abstract:
Bone imaging was done in patients after total replacement arthroplasty of the hip joint every 3rd month using 99mTc-HEDP and 18F. Uptake ratios were estimated over cup/normal hip and femur prosthesis/normal thigh. Ratios decline rapidly and reach a stable level 6-9 months, postoperatively. Eight cases of late infection were predicted correctly 1-3 months before any radiologic evidence was present. In four cases there had been false-positive results with 99mTc-HEDP while 18F gave always correct information except in cases of soft tissue inflammation. Here both 99mTc-HEDP and 18F ratios were elevated. The early diagnosis of late complications after replacement arthroplasty seems to be possible. The clinical significance, however, is low: only one out of eight patients with manifest infection is still on conservative treatment. Bone imaging should be done to exclude late infection as a cause of pain after total replacement arthroplasty of the hip joint only.