Diagnosis of periprosthetic loosening of total hip and knee arthroplasty using Gallium-Zoledronate PET/CT.

PURPOSE

Periprosthetic loosening is a major complication after total hip and knee arthroplasty. Early and accurate diagnosis is essential to choose the right therapeutic path and to avoid further complications. The aim of the study was to evaluate the diagnostic performance of Gallium-Zoledronate ([Ga]Ga-DOTA) PET/CT in detecting periprosthetic loosening in total hip (THA) and total knee arthroplasty (TKA).

METHODS

This retrospective study included 26 patients with painful prosthesis (THA n = 17; TKA n = 16) and clinical suspicion of periprosthetic loosening, but without a confirmed diagnosis. Patients underwent [Ga]Ga-DOTA PET/CT at least one year post-implantation. Diagnosis was confirmed through revision surgery or long-term clinical follow-up, with an observation period of at least 6 months. The analysis included both an assessment of the prosthesis as a unit and a separate evaluation of the individual components. Statistical analysis involved calculating sensitivity, specificity and accuracy using SPSS.

RESULTS

Overall, a sensitivity of 77.8%, a specificity of 95.8% and an accuracy of 90.9% were found for detecting periprosthetic loosening, when considering the prosthesis as a unit. Individual component analyses showed a sensitivity of 71.4% and specificity of 96.2%.

CONCLUSION

The use of [Ga]Ga-DOTA PET/CT in periprosthetic loosening is a remarkable diagnostic tool and a promising approach. In comparison to established radionuclide tracers, Gallium-Zoledronate offers notable advantages due to its availability via Ge/Ga-generators, improving its potential for clinical application.