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The Role of Imaging Techniques to Define a Peri-Prosthetic Hip and Knee Joint Infection: Multidisciplinary Consensus
Carlo Luca Romanò1, Nicola Petrosillo2, Giuseppe Argento3
1Gruppo di Studio SIOT Infezioni-Clinica San Gaudenzio-Novara-Gruppo Policlinico di Monza, University of Milan, 20100 Milan, Italy.
Abstract:
Diagnosing a peri-prosthetic joint infection (PJI) remains challenging despite the availability of a variety of clinical signs, serum and synovial markers, imaging techniques, microbiological and histological findings. Moreover, the one and only true definition of PJI does not exist, which is reflected by the existence of at least six different definitions by independent societies. These definitions are composed of major and minor criteria for defining a PJI, but most of them do not include imaging techniques. This paper highlights the pros and cons of available imaging techniques-X-ray, ultrasound, computed tomography (CT), Magnetic Resonance Imaging (MRI), bone scintigraphy, white blood cell scintigraphy (WBC), anti-granulocyte scintigraphy, and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), discusses the added value of hybrid camera systems-single photon emission tomography/computed tomography (SPECT/CT), PET/CT and PET/MRI and reports consensus answers on important clinical questions that were discussed during the Third European Congress on Inflammation/Infection Imaging in Rome, December 2019.
Insights
Diagnosing peri-prosthetic joint infection (PJI) is difficult due to varied definitions and diagnostic criteria. This review evaluates imaging techniques for improved PJI diagnosis and management.
Area of Science:
- Medical Imaging
- Infectious Diseases
- Orthopedic Surgery
Background:
- Peri-prosthetic joint infection (PJI) diagnosis is complex, lacking a universal definition and relying on diverse criteria.
- Current diagnostic methods for PJI involve clinical, serological, microbiological, and histological assessments, often with limitations.
- The absence of standardized imaging integration in PJI definitions poses a diagnostic challenge.
Framework:
- This paper critically analyzes the advantages and disadvantages of various imaging modalities for PJI detection.
- Key imaging techniques discussed include X-ray, CT, MRI, bone scintigraphy, WBC scintigraphy, and FDG-PET/CT.
- The role of advanced hybrid imaging systems like SPECT/CT, PET/CT, and PET/MRI in PJI diagnosis is explored.
Implementation:
- Evaluation of conventional imaging techniques (X-ray, US, CT, MRI, scintigraphy) for peri-prosthetic joint infection.
- Assessment of novel imaging approaches including FDG-PET/CT and hybrid systems (SPECT/CT, PET/CT, PET/MRI).
- Discussion of consensus findings on critical clinical questions regarding PJI imaging.
Implications:
- Improved understanding of imaging's role can refine PJI diagnostic protocols.
- Enhanced diagnostic accuracy for PJI may lead to earlier intervention and better patient outcomes.
- Standardization of imaging in PJI definitions could improve consistency and comparability across studies.
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