Clinic for Orthopedics and Trauma Surgery, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Clinic for Nuclear Medicine, University Hospital of Bonn, Bonn, Germany.
Arch Orthop Trauma Surg. 2024 Nov;144(11):4775-4781. doi: 10.1007/s00402-024-05562-5. Epub 2024 Oct 1.
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).
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.
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%.
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.
假体周围松动是全髋关节和膝关节置换术后的主要并发症。早期准确的诊断对于选择正确的治疗路径和避免进一步的并发症至关重要。本研究的目的是评估镓-唑来膦酸([Ga]Ga-DOTA) PET/CT 在检测全髋关节置换术(THA)和全膝关节置换术(TKA)假体周围松动中的诊断性能。
本回顾性研究纳入了 26 例有疼痛假体的患者(THA n=17; TKA n=16)，临床怀疑有假体周围松动，但未确诊。患者在植入后至少一年进行[Ga]Ga-DOTA PET/CT 检查。诊断通过翻修手术或长期临床随访确认，观察期至少 6 个月。分析包括对假体作为一个整体的评估和对单个部件的单独评估。统计分析使用 SPSS 计算敏感性、特异性和准确性。
总体而言，当考虑假体作为一个整体时，检测假体周围松动的敏感性为 77.8%，特异性为 95.8%，准确性为 90.9%。对单个部件的分析显示，敏感性为 71.4%，特异性为 96.2%。
[Ga]Ga-DOTA PET/CT 在假体周围松动中的应用是一种卓越的诊断工具，具有广阔的应用前景。与现有的放射性核素示踪剂相比，镓-唑来膦酸由于可以通过 Ge/Ga 发生器获得，具有明显的优势，提高了其在临床应用中的潜力。
