Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty- a new dimension of diagnostics?

BMC Musculoskeletal Disorders

Research Article

Niklaus F Friederich¹  Michael T Hirschmann¹  Helmut Rasch²  Anna Kerner²  Praveen Konala³  Farhad Iranpour³ 

[1] Department of Orthopaedic Surgery and Traumatology, Kantonsspital Bruderholz, CH-4101, Bruderholz, Switzerland;Institute of Radiology and Nuclear Medicine, Kantonsspital Bruderholz, CH-4101, Bruderholz, Switzerland;Musculoskelettal Surgery Department, Imperial College, London, UK;

关键词: Total Knee Arthroplasty;    Knee Pain;    Femoral Component;    Tracer Uptake;    Tibial Component;   

DOI  :  10.1186/1471-2474-12-36

 received in 2010-09-11, accepted in 2011-02-04,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundThe purpose of our study was to evaluate the clinical value of hybrid SPECT/CT for the assessment of patients with painful total knee arthroplasty (TKA).MethodsTwenty-three painful knees in patients following primary TKA were assessed using Tc-99m-HDP-SPECT/CT. Rotational, sagittal and coronal position of the TKA was assessed on 3D-CT reconstructions. The level of the SPECT-tracer uptake (0-10) and its anatomical distribution was mapped using a validated localization scheme. Univariate analysis (Wilcoxon-Mann-Whitney, Spearmean`s-rho test, p < 0.05) was performed to identify any correlations between component position, tracer uptake and diagnosis.ResultsSPECT/CT imaging changed the suspected diagnosis and the proposed treatment in 19/23 (83%) knees. Progression of patellofemoral OA (n = 11), loosening of the tibial (n = 3) and loosening of the femoral component (n = 2) were identified as the leading causes of pain after TKA.Patients with externally rotated tibial trays showed higher tracer uptake in the medial patellar facet (p = 0.049) and in the femur (p = 0.051). Patients with knee pain due to patellofemoral OA showed significantly higher tracer uptake in the patella than others (p < 0.001).ConclusionsSPECT/CT was very helpful in establishing the diagnosis and guiding subsequent management in patients with painful knees after TKA, particularly in patients with patellofemoral problems and malpositioned or loose TKA.

【 授权许可】

CC BY   
© Hirschmann et al; licensee BioMed Central Ltd. 2011