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

BMC Medical Imaging

Research Article

Heiko Wissel¹  Max Seidensticker¹  Holger Amthauer¹  Oliver S Grosser¹  Oliver Dobrindt²  Juri Ruf³  Christoph H Lohmann⁴  Alexander Krueger⁴ 

[1] Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany;Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany;Charité - Universitätsmedizin, Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charitéplatz 1, 10117, Berlin, Germany;Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany;Universitätsklinikum Freiburg, Klinik für Nuklearmedizin, Hugstetter Straße 55, 79106, Freiburg, Germany;Orthopädische Universitätsklinik, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany;

关键词: SPECT/CT;    Total hip arthroplasty;    THR;    Hip pain;    Loosening;   

DOI  :  10.1186/s12880-015-0056-1

 received in 2014-07-17, accepted in 2015-04-22,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsBone 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.ResultsThe 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.ConclusionsSPECT/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.

【 授权许可】

CC BY   
© Dobrindt et al. 2015