Tian Yaxin, Jiang Yanghongyan, Feng Bei, Zhao Tingting, Cai Wenjiao, Dong Yiyuan, Zhao Qian
Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004 China.
First School of Clinical Medicine of Ningxia Medical University, Yinchuan, China.
Indian J Orthop. 2024 Feb 7;58(3):316-322. doi: 10.1007/s43465-024-01095-6. eCollection 2024 Mar.
Prosthetic loosening and infection are still common complications after joint replacement. Over the past few years, single-photon emission computed tomography-computed tomography (SPECT/CT) was widely used and showed unique value based on the combination of anatomic and metabolic information of foci. However, its performance in differentiating between prosthetic loosening and periprosthetic infection after joint replacement is still the focus of clinicians and deserves further investigation.
This retrospective study was aimed to determine whether bone scintigraphy combined with SPECT/CT still can differentiate prosthetic infection from loosening in patients after joint replacement. The differential efficacy in hip and knee prosthesis was also analyzed. Blood biomarkers for the diagnosis of periprosthetic infection were also evaluated.
Data sets of 74 prosthetic joints (including knees and hips), with suspected prosthetic loosening or infection between 2015 and 2021, were evaluated. Besides the results of nuclear imaging, X-ray images and serum biomarker were also recorded. Telephone follow-up and revision surgery after SPECT/CT were used as a gold standard. The sensitivity and accuracy of different imaging modalities were calculated by Chi-square test. The diagnostic efficacy of imaging methods and serum biomarkers were then analyzed by the area under curve (receiver operating characteristic curves, ROC) in SPSS 26.
In all, 47 joints (14 knees and 33 hips) were confirmed as aseptic loosening, while 25 joints (18 knees and 7 hips) were confirmed as infection. The sensitivity and accuracy of SPECT combined with SPECT/CT imaging were the highest (92.86% and 87.84%, respectively). The differential efficacy of bone scintigraphy combined with SPECT/CT imaging was also better than any other single imaging modality. In the analysis of involved prosthesis, prosthetic loosening occurred more in hip prosthesis and knee prosthesis was easily infected ( < 0.05). Finally, the sensitivity of ESR and CRP were 80% and 84%, respectively.
Bone scintigraphy with hybrid SPECT/CT remains encouraging in differentiating prosthetic infection from loosening after joint replacement. The diagnostic efficacy of differentiation in hip prosthesis was better than knee. Serum biomarkers cannot be used alone to differentiate prosthetic infection from loosening.
假体松动和感染仍是关节置换术后常见的并发症。在过去几年中，单光子发射计算机断层扫描-计算机断层扫描（SPECT/CT）被广泛应用，基于病灶的解剖和代谢信息的结合显示出独特的价值。然而，其在区分关节置换术后假体松动和假体周围感染方面的表现仍是临床医生关注的焦点，值得进一步研究。
本回顾性研究旨在确定骨闪烁显像联合SPECT/CT是否仍能区分关节置换术后患者的假体感染与松动。还分析了髋部和膝部假体的鉴别效能。同时评估用于诊断假体周围感染的血液生物标志物。
评估了2015年至2021年间74个疑似假体松动或感染的人工关节（包括膝部和髋部）的数据集。除了核素显像结果外，还记录了X线图像和血清生物标志物。以电话随访和SPECT/CT检查后的翻修手术作为金标准。采用卡方检验计算不同成像方式的敏感性和准确性。然后在SPSS 26中通过曲线下面积（受试者工作特征曲线，ROC）分析成像方法和血清生物标志物的诊断效能。
总共47个关节（14个膝部和33个髋部）被确认为无菌性松动，而25个关节（18个膝部和7个髋部）被确认为感染。SPECT联合SPECT/CT成像的敏感性和准确性最高（分别为92.86%和87.84%）。骨闪烁显像联合SPECT/CT成像的鉴别效能也优于任何其他单一成像方式。在受累假体分析中，髋部假体更容易发生假体松动，膝部假体更容易感染（P<0.05）。最后，血沉（ESR）和C反应蛋白（CRP）的敏感性分别为80%和84%。
骨闪烁显像联合SPECT/CT在区分关节置换术后假体感染与松动方面仍令人鼓舞。髋部假体的鉴别诊断效能优于膝部。血清生物标志物不能单独用于区分假体感染与松动。
