Niccoli Giuseppe, Mercurio Domenico, Cortese Fabrizio
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Acta Biomed. 2017 Jun 7;88(2S):68-77. doi: 10.23750/abm.v88i2-S.6516.
ptic loosening, instability and infection are the major causes of TKA failure. For many years, nuclear medicine (NM) imaging was helpful to frame a painful total joint arthroplasty. The differentiation of septic from aseptic prosthetic loosening is critical. The latest AAOS guidelines to detect periprosthetic joint infection (PJI) restrict the role of NM scintigraphy. On the other hand, several studies suggest that NM imaging plays an important role in the evaluation of patients with painful prosthesis, but its specificity in differentiating aseptic loosening from infection is low. Moreover, scintigraphic exams showed different diagnostic accuracy in TKA compared to total hip arthroplasty (THA).
To assess and discuss current knowledges about the diagnostic value of the various scans in TKA failure alone.
We perform a pubmed/medline search to identify all papers published in the literature matching the following key words: "total knee arthroplasty", "bone", "scintigraphy", "imaging", "three-phase", "triple-phase", "99mTc-HDP", "99mTc-MDP", "99mTc-hydroxymethane diphosphonate", and "99m Tc-methylenediphosphonate", "leukocyte scanning", "labeled leukocyte scintigraphy", "antigranulocyte", "nuclear medicine", "septic loosening", "aseptic loosening" and "infection".
Three phases bone scintigraphy results an early diagnostic screening test or part of the preoperative tests for painful TKA and when PJI is suspected. Instead, leukocyte/bone marrow scintigraphy is superior to other scintigraphic tools in diagnosis of TKA infections. Granulocyte scintigraphy, seems to be an excellent choice when the diagnosis is unclear. Moreover, nuclear diagnostic tests showed different diagnostic accuracy between TKA and THA.
Although nuclear diagnostic tests for THA failure are superior in diagnostic accuracy compared to TKA, NM scintigraphy is still an effective tool in the identification of chronic, low grade PJI. To date, scintigraphic exams have an higher levels of sensitivity, specificity and accuracy. Currently, leukocyte/bone marrow scintigraphy is considered the gold standard for this aim. Nevertheless, further studies are needed to assess and improve the accuracy of the scintigraphic exams in order to discriminate the causes of failure for painful TKA.
假体松动、不稳定和感染是全膝关节置换术（TKA）失败的主要原因。多年来，核医学（NM）成像有助于对疼痛的全关节置换术进行评估。区分感染性假体松动和无菌性假体松动至关重要。美国骨与软组织外科医师学会（AAOS）最新的检测假体周围关节感染（PJI）的指南限制了NM闪烁扫描的作用。另一方面，一些研究表明，NM成像在评估疼痛假体患者中起重要作用，但其区分无菌性松动和感染的特异性较低。此外，与全髋关节置换术（THA）相比，闪烁扫描检查在TKA中的诊断准确性不同。
评估和讨论目前关于各种扫描在单纯TKA失败中的诊断价值的知识。
我们在PubMed/Medline上进行搜索，以识别文献中发表的所有与以下关键词匹配的论文：“全膝关节置换术”、“骨”、“闪烁扫描”、“成像”、“三相”、“三相扫描”、“99m锝-亚甲基二膦酸盐（99mTc-HDP）”、“99m锝-亚甲基二膦酸盐（99mTc-MDP）”、“99m锝-羟甲基二膦酸盐”、“99m锝-亚甲基二膦酸盐”、“白细胞扫描”、“标记白细胞闪烁扫描”、“抗粒细胞”、“核医学”、“感染性松动”、“无菌性松动”和“感染”。
三相骨闪烁扫描是疼痛性TKA以及怀疑有PJI时的早期诊断筛查试验或术前检查的一部分。相反，白细胞/骨髓闪烁扫描在诊断TKA感染方面优于其他闪烁扫描工具。当诊断不明确时，粒细胞闪烁扫描似乎是一个很好的选择。此外，核诊断试验在TKA和THA之间显示出不同的诊断准确性。
虽然THA失败的核诊断试验在诊断准确性上优于TKA，但NM闪烁扫描仍是识别慢性低度PJI的有效工具。迄今为止，闪烁扫描检查具有更高的敏感性、特异性和准确性水平。目前，白细胞/骨髓闪烁扫描被认为是实现这一目标的金标准。然而，需要进一步研究来评估和提高闪烁扫描检查的准确性，以区分疼痛性TKA失败的原因。
