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Hybrid SPECT/CT for the assessment of a painful hip after uncemented total hip arthroplasty.

Dobrindt O, Amthauer H, Krueger A, Ruf J, Wissel H, Grosser OS, Seidensticker M, Lohmann CH - BMC Med Imaging (2015)

Bottom Line: Selection of the patients required an inconclusive radiograph, normal serum levels of inflammatory parameters (CRP and ESR) or a negative aspiration of the hip joint prior to the examination.Reasons were aseptic loosening (n = 5), spine-related (n = 5), heterotopic ossification (n = 5), neuronal (n = 1), septic loosening (n = 1) and periprosthetic stress fracture (n = 1).Furthermore differential diagnoses may be detected with a whole-body scan and mechanical or osseous failure is covered by CT-imaging.

View Article: PubMed Central - PubMed

Affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. o.dobrindt@gmail.com.

ABSTRACT

Background: The diagnosis of hip pain after total hip replacement (THR) represents a highly challenging question that is of increasing concern to orthopedic surgeons. This retrospective study assesses bone scintigraphy with Hybrid SPECT/CT for the diagnosis of painful THR in a selected cohort of patients.

Methods: Bone SPECT/CT datasets of 23 patients (mean age 68.9 years) with a painful hip after THR were evaluated. Selection of the patients required an inconclusive radiograph, normal serum levels of inflammatory parameters (CRP and ESR) or a negative aspiration of the hip joint prior to the examination. The standard of reference was established by an interdisciplinary adjudication-panel using all imaging data and clinical follow-up data (>12 month). Pathological and physiological uptake patterns were defined and applied.

Results: The cause of pain in this study group could be determined in 18 out of 23 cases. Reasons were aseptic loosening (n = 5), spine-related (n = 5), heterotopic ossification (n = 5), neuronal (n = 1), septic loosening (n = 1) and periprosthetic stress fracture (n = 1). In (n = 5) cases the cause of hip pain could not be identified. SPECT/CT imaging correctly identified the cause of pain in (n = 13) cases, in which the integrated CT-information led to the correct diagnosis in (n = 4) cases, mainly through superior anatomic correlation. Loosening was correctly assessed in all cases with a definite diagnosis.

Conclusions: SPECT/CT of THA reliably detects or rules out loosening and provides valuable information about heterotopic ossifications. Furthermore differential diagnoses may be detected with a whole-body scan and mechanical or osseous failure is covered by CT-imaging. SPECT/CT holds great potential for imaging-based assessment of painful prostheses.

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Related in: MedlinePlus

Differentiation between heterotopic ossifications and loosening of the acetabular component. 58-year old male with pain in the left hip that started several months after surgery. Using SPECT/CT, the increased uptake can be traced to heterotopic ossifications close to the acetabular component differentiating between loosening of the cup A)-C). D) shows the planar SPECT image of the left hip with increased acitivity around the cup that cannot clearly be assigned to a specific structure. After a subsequent scintigraphic examination proving inactivity of the ossifications, these were removed surgically.
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Fig1: Differentiation between heterotopic ossifications and loosening of the acetabular component. 58-year old male with pain in the left hip that started several months after surgery. Using SPECT/CT, the increased uptake can be traced to heterotopic ossifications close to the acetabular component differentiating between loosening of the cup A)-C). D) shows the planar SPECT image of the left hip with increased acitivity around the cup that cannot clearly be assigned to a specific structure. After a subsequent scintigraphic examination proving inactivity of the ossifications, these were removed surgically.

Mentions: In 4 out of 18 patients the analysis of SPECT/CT data was superior to combined evaluation of planar scintigraphy, SPECT, and radiographs. In two patients SPECT/CT allowed the exclusion of prosthetic loosening, as the increased tracer uptake seen in planar scintigraphy and SPECT could be attributed to extra-articular heterotopic ossifications. (Figure 1.) In one patient the combination of a loosened cerclage placed for stabilization of a periprosthetic femoral shaft fracture and the consecutive loosening of the femoral prosthetic implant component was shown. Although the pathological tracer uptake would also have been discernible in conventional scintigraphy and SPECT, the causality and complexity of these interactive findings became only evident after SPECT/CT interpretation. In another patient SPECT/CT showed no pathology of the hip prosthesis, but revealed a symptomatic spinal stenosis.Figure 1


Hybrid SPECT/CT for the assessment of a painful hip after uncemented total hip arthroplasty.

Dobrindt O, Amthauer H, Krueger A, Ruf J, Wissel H, Grosser OS, Seidensticker M, Lohmann CH - BMC Med Imaging (2015)

Differentiation between heterotopic ossifications and loosening of the acetabular component. 58-year old male with pain in the left hip that started several months after surgery. Using SPECT/CT, the increased uptake can be traced to heterotopic ossifications close to the acetabular component differentiating between loosening of the cup A)-C). D) shows the planar SPECT image of the left hip with increased acitivity around the cup that cannot clearly be assigned to a specific structure. After a subsequent scintigraphic examination proving inactivity of the ossifications, these were removed surgically.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4459070&req=5

Fig1: Differentiation between heterotopic ossifications and loosening of the acetabular component. 58-year old male with pain in the left hip that started several months after surgery. Using SPECT/CT, the increased uptake can be traced to heterotopic ossifications close to the acetabular component differentiating between loosening of the cup A)-C). D) shows the planar SPECT image of the left hip with increased acitivity around the cup that cannot clearly be assigned to a specific structure. After a subsequent scintigraphic examination proving inactivity of the ossifications, these were removed surgically.
Mentions: In 4 out of 18 patients the analysis of SPECT/CT data was superior to combined evaluation of planar scintigraphy, SPECT, and radiographs. In two patients SPECT/CT allowed the exclusion of prosthetic loosening, as the increased tracer uptake seen in planar scintigraphy and SPECT could be attributed to extra-articular heterotopic ossifications. (Figure 1.) In one patient the combination of a loosened cerclage placed for stabilization of a periprosthetic femoral shaft fracture and the consecutive loosening of the femoral prosthetic implant component was shown. Although the pathological tracer uptake would also have been discernible in conventional scintigraphy and SPECT, the causality and complexity of these interactive findings became only evident after SPECT/CT interpretation. In another patient SPECT/CT showed no pathology of the hip prosthesis, but revealed a symptomatic spinal stenosis.Figure 1

Bottom Line: Selection of the patients required an inconclusive radiograph, normal serum levels of inflammatory parameters (CRP and ESR) or a negative aspiration of the hip joint prior to the examination.Reasons were aseptic loosening (n = 5), spine-related (n = 5), heterotopic ossification (n = 5), neuronal (n = 1), septic loosening (n = 1) and periprosthetic stress fracture (n = 1).Furthermore differential diagnoses may be detected with a whole-body scan and mechanical or osseous failure is covered by CT-imaging.

View Article: PubMed Central - PubMed

Affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. o.dobrindt@gmail.com.

ABSTRACT

Background: The diagnosis of hip pain after total hip replacement (THR) represents a highly challenging question that is of increasing concern to orthopedic surgeons. This retrospective study assesses bone scintigraphy with Hybrid SPECT/CT for the diagnosis of painful THR in a selected cohort of patients.

Methods: Bone SPECT/CT datasets of 23 patients (mean age 68.9 years) with a painful hip after THR were evaluated. Selection of the patients required an inconclusive radiograph, normal serum levels of inflammatory parameters (CRP and ESR) or a negative aspiration of the hip joint prior to the examination. The standard of reference was established by an interdisciplinary adjudication-panel using all imaging data and clinical follow-up data (>12 month). Pathological and physiological uptake patterns were defined and applied.

Results: The cause of pain in this study group could be determined in 18 out of 23 cases. Reasons were aseptic loosening (n = 5), spine-related (n = 5), heterotopic ossification (n = 5), neuronal (n = 1), septic loosening (n = 1) and periprosthetic stress fracture (n = 1). In (n = 5) cases the cause of hip pain could not be identified. SPECT/CT imaging correctly identified the cause of pain in (n = 13) cases, in which the integrated CT-information led to the correct diagnosis in (n = 4) cases, mainly through superior anatomic correlation. Loosening was correctly assessed in all cases with a definite diagnosis.

Conclusions: SPECT/CT of THA reliably detects or rules out loosening and provides valuable information about heterotopic ossifications. Furthermore differential diagnoses may be detected with a whole-body scan and mechanical or osseous failure is covered by CT-imaging. SPECT/CT holds great potential for imaging-based assessment of painful prostheses.

Show MeSH
Related in: MedlinePlus