Prosthesis infection: diagnosis after total joint arthroplasty with three-phase bone scintigraphy

This study investigated the diagnostic validity of Three-phase bone scintigraphy (TPBS) for diagnosing prosthetic joint infection (PJI) in cases of suspected infected total joint arthroplasty.

We performed a systematic search using MEDLINE, EMBASE, and OVID databases to conduct pertinent data published between January 1990 and December 2013. Meta-analysis was used to pool sensitivity, specificity, diagnostic odds ratios (DORs), positive likelihood ratios (PLR), negative likelihood ratios (NLR), the area under the receiver-operating characteristic curve (AUC), and post-test probability. Heterogeneity and publication bias were assessed, and subgroup and meta-regression analyses were conducted.

Twenty articles including a total of 704 patients were considered for analysis. The pooled sensitivity and specificity for using TPBS to detect PJI was 0.83 [95 % confidence interval (CI) 0.72-0.90] and 0.73 (95 % CI 0.65-0.80), respectively. The AUC, PLR, NLR, and DOR were 0.85 (95 % CI 0.81-0.87), 3.1 (95 % CI 2.4-4.1), 0.23 (95 % CI 0.14-0.38), and 14 (95 % CI 7-26), respectively. Low clinical scenario-negative post-test probabilities were 7 %, and high clinical scenario-positive post-test probabilities were 90 %. Subgroup analyses indicated that the sensitivity and specificity of TPBS for detecting infected arthroplasty of the hip (0.81 and 0.78, respectively) were significantly higher than those of the knee (0.75 and 0.55, respectively; p < 0.05). There was no significant evidence of publication bias (p = 0.34).

TPBS has reasonable diagnostic value for detecting PJI and could be performed as a screening test or part of preoperative tests and analysed in conjunction with other findings at the time of suspected PJI, especially in those infections affecting the hip.