Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 10/2010

01-10-2010 | Orthopaedic Surgery

Use of 18F-FDG-PET in the diagnosis of endoprosthetic loosening of knee and hip implants

Authors: Susanne Mayer-Wagner, Wolfgang Mayer, Sonja Maegerlein, Rainer Linke, Volkmar Jansson, Peter E. Müller

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2010

Login to get access

Abstract

Introduction

To diagnose septic and aseptic loosening 18-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has been described with good results for hip arthroplasties. The purpose of the present study was to examine whether there is a difference of feasibility in detecting loosening of hip versus knee prostheses by use of 18F-FDG-PET.

Patients

Thirty-two patients with lower limb arthroplasty complaints (74 components) were studied preoperatively with 18F-FDG-PET. The interpretation of 18F-FDG-PET was done according to evaluated criteria. The final diagnosis based on intraoperative findings in all cases including microbiological examinations.

Results

For hip arthroplasty sensitivity/specificity of 18F-FDG-PET towards implant loosening was 80%/87%. For infectious loosening of hip endoprostheses sensitivity/specificity was 67%/83%. In knee endoprostheses sensitivity/specificity for loosening was 56%/82% and 14%/89% for infection. The sensitivity of the results for knee and hip joints in regard to infectious versus aseptic loosening was significantly different.

Conclusion

We confirm that 18F-FDG-PET is an appropriate tool to diagnose hip arthroplasty loosening. Differing from that 18F-FDG-PET showed a significant lower sensitivity/specificity in detecting septic loosening of knee endoprostheses. It may therefore be necessary to use different methods to diagnose loosening of endoprostheses depending on the type of implant which is examined.
Literature
1.
go back to reference Barrack RL, Jennings RW, Wolfe MW, Bertot AJ (1997) The Coventry award: the value of preoperative aspiration before total knee revision. Clin Orthop Relat Res 345:8–16CrossRefPubMed Barrack RL, Jennings RW, Wolfe MW, Bertot AJ (1997) The Coventry award: the value of preoperative aspiration before total knee revision. Clin Orthop Relat Res 345:8–16CrossRefPubMed
2.
go back to reference Bernard L, Lubbeke A, Stern R, Bru JP, Feron JM, Peyramond D, Denormandie P, Arvieux C, Chirouze C, Perronne C, Hoffmeyer P (2004) Value of preoperative investigations in diagnosing prosthetic joint infection: retrospective cohort study and literature review. Scand J Infect Dis 36(6–7):410–416CrossRefPubMed Bernard L, Lubbeke A, Stern R, Bru JP, Feron JM, Peyramond D, Denormandie P, Arvieux C, Chirouze C, Perronne C, Hoffmeyer P (2004) Value of preoperative investigations in diagnosing prosthetic joint infection: retrospective cohort study and literature review. Scand J Infect Dis 36(6–7):410–416CrossRefPubMed
3.
go back to reference Chacko TK, Zhuang H, Stevenson K, Moussavian B, Alavi A (2002) The importance of the location of fluorodeoxyglucose uptake in periprosthetic infection in painful hip. Nucl Med Commun 23(9):851–855CrossRefPubMed Chacko TK, Zhuang H, Stevenson K, Moussavian B, Alavi A (2002) The importance of the location of fluorodeoxyglucose uptake in periprosthetic infection in painful hip. Nucl Med Commun 23(9):851–855CrossRefPubMed
4.
go back to reference Chryssikos T, Parvizi J, Ghanem E, Newberg A, Zhuang H, Alavi A (2008) FDG-PET Imaging can diagnose periprosthetic infection of the hip. Clin Orthop Relat Res 466:1338–1342CrossRefPubMed Chryssikos T, Parvizi J, Ghanem E, Newberg A, Zhuang H, Alavi A (2008) FDG-PET Imaging can diagnose periprosthetic infection of the hip. Clin Orthop Relat Res 466:1338–1342CrossRefPubMed
5.
go back to reference Cremerius U, Mumme T, Reinartz P, Wirtz D, Niethard FU, Buell U (2003) Analysis of 18F-FDG uptake patterns in PET for diagnosis of septic and aseptic loosening after total hip arthroplasty. Nuklearmedizin 42:234–239PubMed Cremerius U, Mumme T, Reinartz P, Wirtz D, Niethard FU, Buell U (2003) Analysis of 18F-FDG uptake patterns in PET for diagnosis of septic and aseptic loosening after total hip arthroplasty. Nuklearmedizin 42:234–239PubMed
6.
go back to reference Fitzgerald RH Jr (1995) Diagnosis and management of the infected hip prosthesis. Orthopedics 18(9):833–835PubMed Fitzgerald RH Jr (1995) Diagnosis and management of the infected hip prosthesis. Orthopedics 18(9):833–835PubMed
7.
go back to reference Furnes O, Lie SA, Espehaug B, Vollset SE, Engesaeter LB, Havelin LI (2001) Hip disease and the prognosis of total hip replacements. A review of 53.698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987–1999. J Bone Joint Surg Br 83(4):579–586CrossRefPubMed Furnes O, Lie SA, Espehaug B, Vollset SE, Engesaeter LB, Havelin LI (2001) Hip disease and the prognosis of total hip replacements. A review of 53.698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987–1999. J Bone Joint Surg Br 83(4):579–586CrossRefPubMed
8.
go back to reference Herberts P, Malchau H (2000) Long term registration has improved the quality of hip replacement a review of the Swedish THR Register comparing 160.000 cases. Acta Orthop Scand 71(2):111–121CrossRefPubMed Herberts P, Malchau H (2000) Long term registration has improved the quality of hip replacement a review of the Swedish THR Register comparing 160.000 cases. Acta Orthop Scand 71(2):111–121CrossRefPubMed
9.
go back to reference Keogh CF, Munk PL, Gee R, Chan LP, Marchinkow LO (2003) Imaging of the painful hip arthroplasty. Am J Roentgenol 180(1):115–120 Keogh CF, Munk PL, Gee R, Chan LP, Marchinkow LO (2003) Imaging of the painful hip arthroplasty. Am J Roentgenol 180(1):115–120
10.
go back to reference Kisielinski K, Cremerius U, Bull U, Hermanns B, Wirtz DC, Niethard FU (2003) First experiences with fluorodeoxyglucose-positron-emission tomography (FDG-PET) in the evaluation of painful total knee and hip joint replacements. Z Orthop Ihre Grenzgeb 141(2):153–159CrossRefPubMed Kisielinski K, Cremerius U, Bull U, Hermanns B, Wirtz DC, Niethard FU (2003) First experiences with fluorodeoxyglucose-positron-emission tomography (FDG-PET) in the evaluation of painful total knee and hip joint replacements. Z Orthop Ihre Grenzgeb 141(2):153–159CrossRefPubMed
11.
go back to reference Kisielinski K, Cremerius U, Reinartz P, Niethard FU (2003) Fluordeoxyglucose positron emission tomography detection of inflammatory reactions due to polyethylene wear in total hip arthroplasty. Athroplasty 18(4):528–532CrossRef Kisielinski K, Cremerius U, Reinartz P, Niethard FU (2003) Fluordeoxyglucose positron emission tomography detection of inflammatory reactions due to polyethylene wear in total hip arthroplasty. Athroplasty 18(4):528–532CrossRef
12.
go back to reference Love C, Marwin S, Tomas M, Krauss E, Tronco G, Bhargava K, Nichols K, Palestro C (2004) Diagnosing infection in the failed joint replacement: a comparison of coincidence detection 18F-FDG and 111In-labeled leukocytes/99 m Tc-sulfur colloid marrow imaging. J Nucl Med 45(11):1864–1871PubMed Love C, Marwin S, Tomas M, Krauss E, Tronco G, Bhargava K, Nichols K, Palestro C (2004) Diagnosing infection in the failed joint replacement: a comparison of coincidence detection 18F-FDG and 111In-labeled leukocytes/99 m Tc-sulfur colloid marrow imaging. J Nucl Med 45(11):1864–1871PubMed
13.
go back to reference Love C, Pugliese PV, Afriyie MO, Tomas MB, Marwin SE, Palestro CJ (2000) Utility of F-18 FDG Imaging for diagnosing the infected joint replacement. Clin Positron Imaging 3(4):159CrossRefPubMed Love C, Pugliese PV, Afriyie MO, Tomas MB, Marwin SE, Palestro CJ (2000) Utility of F-18 FDG Imaging for diagnosing the infected joint replacement. Clin Positron Imaging 3(4):159CrossRefPubMed
14.
go back to reference Mulamba L, Ferrant A, Leners N, de Nayer P, Rombouts JJ, Vincent A (1983) Indium–111 leucocyte scanning in the evaluation of painful hip arthroplasty. Acta Orthop Scand. 54(5):695–697CrossRefPubMed Mulamba L, Ferrant A, Leners N, de Nayer P, Rombouts JJ, Vincent A (1983) Indium–111 leucocyte scanning in the evaluation of painful hip arthroplasty. Acta Orthop Scand. 54(5):695–697CrossRefPubMed
15.
go back to reference Mumme T, Cremerius U, Hermanns B, Neuss M, Müller-Rath R, Buell U, Wirtz DC (2003) FDG PET as an early nuclear medical diagnostic tool for aseptic wear-induced loosening of hip joint endoprotheses. Unfallchirurg 106:592–599CrossRefPubMed Mumme T, Cremerius U, Hermanns B, Neuss M, Müller-Rath R, Buell U, Wirtz DC (2003) FDG PET as an early nuclear medical diagnostic tool for aseptic wear-induced loosening of hip joint endoprotheses. Unfallchirurg 106:592–599CrossRefPubMed
16.
go back to reference Mumme T, Reinartz J, Alfer J, Müller-Rath R, Buell U, Wirtz DC (2005) Diagnostic values of positron emission tomography versus triple phase bone scan in hip arthroplasty loosening. Arch Orthop Trauma Surg 125:322–329CrossRefPubMed Mumme T, Reinartz J, Alfer J, Müller-Rath R, Buell U, Wirtz DC (2005) Diagnostic values of positron emission tomography versus triple phase bone scan in hip arthroplasty loosening. Arch Orthop Trauma Surg 125:322–329CrossRefPubMed
17.
go back to reference Reinartz P, Mumme T, Hermanns B, Cremerius U, Wirtz DC, Schaefer WM, Niethard FU, Buell U (2005) Radionuclide imaging of the painful hip arthroplasty: positron-emission tomography versus triple-phase bone scanning. J Bone Joint Surg Br 87(4):465–470CrossRefPubMed Reinartz P, Mumme T, Hermanns B, Cremerius U, Wirtz DC, Schaefer WM, Niethard FU, Buell U (2005) Radionuclide imaging of the painful hip arthroplasty: positron-emission tomography versus triple-phase bone scanning. J Bone Joint Surg Br 87(4):465–470CrossRefPubMed
18.
go back to reference Stumpe KD, Notzli HP, Zanetti M, Kamel EM, Hany TF, Gorres GW, von Schulthess GK, Hodler J (2004) FDG PET for differentiation of infection and aseptic loosening in total hip replacements: comparison with conventional radiography and three-phase bone scintigraphy. Radiology 231(2):333–341CrossRefPubMed Stumpe KD, Notzli HP, Zanetti M, Kamel EM, Hany TF, Gorres GW, von Schulthess GK, Hodler J (2004) FDG PET for differentiation of infection and aseptic loosening in total hip replacements: comparison with conventional radiography and three-phase bone scintigraphy. Radiology 231(2):333–341CrossRefPubMed
19.
go back to reference Stumpe KD, Romero J, Ziegler O, Kamel EM, von Schulthess GK, Strobel K, Hodler J (2006) The value of FDG-PET in patients with painful total knee arthroplasty. Eur J Nucl Med 33:1218–1225CrossRef Stumpe KD, Romero J, Ziegler O, Kamel EM, von Schulthess GK, Strobel K, Hodler J (2006) The value of FDG-PET in patients with painful total knee arthroplasty. Eur J Nucl Med 33:1218–1225CrossRef
20.
go back to reference Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Green Leaf JF, Patel R (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357(7):654–663CrossRefPubMed Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Green Leaf JF, Patel R (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357(7):654–663CrossRefPubMed
21.
go back to reference Van Acker F, Nuyts J, Maes A, Vanquickenborne B, Stuyck J, Bellemans J, Vleugels S, Bornemans G, Mortelmans L (2001) FDG-PET, 99mTc-HMPAO white blood cell SPECT and bone scintigraphy in the evaluation of painful total knee arthroplasties. Eur J Nucl Med 28:1496–1504CrossRefPubMed Van Acker F, Nuyts J, Maes A, Vanquickenborne B, Stuyck J, Bellemans J, Vleugels S, Bornemans G, Mortelmans L (2001) FDG-PET, 99mTc-HMPAO white blood cell SPECT and bone scintigraphy in the evaluation of painful total knee arthroplasties. Eur J Nucl Med 28:1496–1504CrossRefPubMed
22.
go back to reference Vanquickenborne B, Maes A, Nuyts J, Van Acker F, Stuyck J, Mulier M, Verbruggen A, Mortelmans L (2003) The value of 18FDG-PET for the detection of infected hip prosthesis. Eur J Nucl Med Mol Imaging 30(5):705–715CrossRefPubMed Vanquickenborne B, Maes A, Nuyts J, Van Acker F, Stuyck J, Mulier M, Verbruggen A, Mortelmans L (2003) The value of 18FDG-PET for the detection of infected hip prosthesis. Eur J Nucl Med Mol Imaging 30(5):705–715CrossRefPubMed
23.
go back to reference Zhuang H, Duarte PS, Pourdehnad M, Maes A, Van Acker F, Shnier D, Garino JP, Fitzgerald RH, Alavi A (2001) The promising role of 18F-FDG PET in detecting infected lower limb prosthesis implants. J Nucl Med 42(1):44–48PubMed Zhuang H, Duarte PS, Pourdehnad M, Maes A, Van Acker F, Shnier D, Garino JP, Fitzgerald RH, Alavi A (2001) The promising role of 18F-FDG PET in detecting infected lower limb prosthesis implants. J Nucl Med 42(1):44–48PubMed
24.
go back to reference Zoccali C, Teori G, Salducca N (2008) The role of FDG-PET in distinguishing between septic and aseptic loosening in hip prosthesis: a review of literature. Int Orthop 32:567–571CrossRef Zoccali C, Teori G, Salducca N (2008) The role of FDG-PET in distinguishing between septic and aseptic loosening in hip prosthesis: a review of literature. Int Orthop 32:567–571CrossRef
Metadata
Title
Use of 18F-FDG-PET in the diagnosis of endoprosthetic loosening of knee and hip implants
Authors
Susanne Mayer-Wagner
Wolfgang Mayer
Sonja Maegerlein
Rainer Linke
Volkmar Jansson
Peter E. Müller
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 10/2010
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-009-1000-z

Other articles of this Issue 10/2010

Archives of Orthopaedic and Trauma Surgery 10/2010 Go to the issue