Koob Sebastian, Gaertner Florian C, Jansen Tom Rainer, Schmolders Jan, Gravius Sascha, Strunk Holger, Wirtz Dieter Christian, Essler Markus
Clinic for Orthopedics and Trauma Surgery, University of Bonn, Bonn, Germany.
Clinic for Nuclear Medicine, University of Bonn, Bonn, Germany.
Oncotarget. 2019 Mar 15;10(22):2203-2211. doi: 10.18632/oncotarget.26762.
Periprosthetic loosening, either aseptic or induced by periprosthetic joint infection remains a major long term complication and challenge in orthopedics and trauma surgery. Sensitivity of potential loosening of the material and other causes of a painful prosthesis is essential for choosing the respective treatment option and providing the needed resources. F-Fluoride is a radiopharmaceutical which shows a high affinity to bone and a rapid blood clearance. The objective of this study was to assess F-Fluoride PET/CT´s sensitivity and specificity in diagnosing periprosthetic loosening in total hip and knee arthroplasty. We included 26 patients with 24 hip and 13 knee prostheses in our retrospective study with radiological or clinical suspicion of peri-prosthetic loosening at least one year after implantation. Results of F-Fluoride PET/CT imaging were compared with surgical results or clinical follow-up if surgery was not performed. On the basis of our data we found a sensitivity of 95.00 %, a specificity of 87.04 % and an accuracy of 89.19 % for F-Fluoride PET/CT. The results of our study show that F-Fluoride PET/CT is a useful and promising technique in diagnosing periprosthetic loosening of total hip and knee arthroplasties. Further investigation should focus on different uptake patterns of the isotope in periprosthetic joint infection and therefore distinguishing aseptic from septic loosening and enhancing the diagnostic value of this imaging method.
假体周围松动，无论是无菌性的还是由假体周围关节感染引起的，仍然是骨科和创伤外科的主要长期并发症和挑战。了解假体潜在松动的敏感性以及其他导致假体疼痛的原因，对于选择相应的治疗方案和提供所需资源至关重要。F-氟化物是一种放射性药物，对骨骼具有高亲和力且血液清除迅速。本研究的目的是评估F-氟化物PET/CT在诊断全髋关节和膝关节置换术中假体周围松动的敏感性和特异性。我们纳入了26例患者，共24个髋关节假体和13个膝关节假体，进行回顾性研究，这些患者在植入至少一年后有影像学或临床怀疑存在假体周围松动。将F-氟化物PET/CT成像结果与手术结果或（若未进行手术）临床随访结果进行比较。基于我们的数据，F-氟化物PET/CT的敏感性为95.00%，特异性为87.04%，准确性为89.19%。我们的研究结果表明，F-氟化物PET/CT在诊断全髋关节和膝关节置换术的假体周围松动方面是一种有用且有前景的技术。进一步的研究应聚焦于该同位素在假体周围关节感染中的不同摄取模式，从而区分无菌性松动和感染性松动，并提高这种成像方法的诊断价值。
