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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

Example of physiological tracer uptake in THA. 77-year old male patient with a diaphyseal fixating stem of the right hip, suffering from pain in the right hip. C) shows the stem in varus position and a radiolucent line (stress shielding) in Gruen zone 1. A), B) and D) show increased bone metabolism in the greater trochanter. This represents physiological enhancement and is consistent with the grading F2,1. After further investigations a spine-related cause of the pain was diagnosed via MRI.
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Fig4: Example of physiological tracer uptake in THA. 77-year old male patient with a diaphyseal fixating stem of the right hip, suffering from pain in the right hip. C) shows the stem in varus position and a radiolucent line (stress shielding) in Gruen zone 1. A), B) and D) show increased bone metabolism in the greater trochanter. This represents physiological enhancement and is consistent with the grading F2,1. After further investigations a spine-related cause of the pain was diagnosed via MRI.

Mentions: In this study-group three basic stem-types of total hip arthroplasty were examined: Stems with distal (diaphyseal) fixation (Figure 2A), stems with metaphyseal/diaphyseal fixation (Figure 2B) and short stems with proximal fixation. The crucial fixation zone of the distal locking stem is the cortical contact-zone in the diaphysis [16] (Gruen zones 2,3,5,6), radiolucency or increased tracer uptake at the bone-prosthesis interface in this area indicates loosening. (Figure 3) Increased uptake at the tip of the prosthesis only in combination with signs of loosening elsewhere was interpreted as axial movement of the stem and therefore also as loosening. Proximal radiolucency medial or lateral of the stem (Gruen zones 1,7), so-called stress shielding is observed frequently and does not indicate loosening. (Figure 4) Stems with diaphyseal fixation may show signs of loosening at the proximal end of the stem, due to slight movement or swinging of the prosthesis [17].Figure 3


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)

Example of physiological tracer uptake in THA. 77-year old male patient with a diaphyseal fixating stem of the right hip, suffering from pain in the right hip. C) shows the stem in varus position and a radiolucent line (stress shielding) in Gruen zone 1. A), B) and D) show increased bone metabolism in the greater trochanter. This represents physiological enhancement and is consistent with the grading F2,1. After further investigations a spine-related cause of the pain was diagnosed via MRI.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Example of physiological tracer uptake in THA. 77-year old male patient with a diaphyseal fixating stem of the right hip, suffering from pain in the right hip. C) shows the stem in varus position and a radiolucent line (stress shielding) in Gruen zone 1. A), B) and D) show increased bone metabolism in the greater trochanter. This represents physiological enhancement and is consistent with the grading F2,1. After further investigations a spine-related cause of the pain was diagnosed via MRI.
Mentions: In this study-group three basic stem-types of total hip arthroplasty were examined: Stems with distal (diaphyseal) fixation (Figure 2A), stems with metaphyseal/diaphyseal fixation (Figure 2B) and short stems with proximal fixation. The crucial fixation zone of the distal locking stem is the cortical contact-zone in the diaphysis [16] (Gruen zones 2,3,5,6), radiolucency or increased tracer uptake at the bone-prosthesis interface in this area indicates loosening. (Figure 3) Increased uptake at the tip of the prosthesis only in combination with signs of loosening elsewhere was interpreted as axial movement of the stem and therefore also as loosening. Proximal radiolucency medial or lateral of the stem (Gruen zones 1,7), so-called stress shielding is observed frequently and does not indicate loosening. (Figure 4) Stems with diaphyseal fixation may show signs of loosening at the proximal end of the stem, due to slight movement or swinging of the prosthesis [17].Figure 3

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