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Three-phase Technetium-99m bone scanning in patients with pain in the knee region after cemented total knee arthroplasty

  • Original Article • KNEE - ARTHROPLASTY
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Our aim was to question the usefulness of a three-phase bone scan in the evaluation of pain in the knee region after TKR. Our hypothesis was that an abnormal investigation had a poor association with the presence of infection or loosening, and did not provide any additional diagnostic information above that already available through other standard investigations.

Methods

A retrospective study over a 24-month period was performed comprising 118 patients investigated with a TPBS. Investigations were summarised and analysed, and were classified as entirely normal, possibly abnormal, and definitely abnormal.

Results

Thirty-three per cent (39/118) of TPBSs were reported as being entirely normal, 59% (69/118) as possibly abnormal, and 8% (10/118) as definitely abnormal. During the 24-month study period, 131 revision TKR procedures were performed at our institution; 9% (12/131) were investigated with TPBS and 91% (119/131) were not. No patient with an entirely normal pre-operative TPBS underwent revision TKR surgery. Eighty-five per cent (67/79) with an abnormal TPBS were managed conservatively. In our series, a TPBS had a positive predictive value of 2.53%, a negative predictive value of 100%, with an overall accuracy of 34.75% with 100% sensitivity (97.5% one-sided confidence interval 0–24.71%), and 33.62% specificity (95% confidence interval 53.29–72.37%), in the diagnosis of infection, or loosening with concurrent infection in determining the indication for revision surgery.

Conclusion

A TPBS should only be considered following clinical evaluation, serological investigation, diagnostic imaging, and microbiological analysis of fluid obtained from arthrocentesis by a specialist revision arthroplasty surgeon. A TPBS may be useful in the situation where abnormal serology is present, but where repeated joint aspirations samples are inconclusive.

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Acknowledgements

We would like to acknowledge the support of our Statistical Advisor Dr. Roy J. Powell, B.Sc. (Hons), Ph.D., CBIOL, FSB, FHEA. Research Design Consultant, Research Design Service (RDS) South West.

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Authors and Affiliations

  1. Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK

    Daniel S. Hill, Denis Kinsella & Andrew D. Toms

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  1. Daniel S. Hill
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  2. Denis Kinsella
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  3. Andrew D. Toms
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Correspondence to Daniel S. Hill.

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The National Research Ethics Committee reviewed the protocol for this work and stated that formal ethical approval was not required.

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Hill, D.S., Kinsella, D. & Toms, A.D. Three-phase Technetium-99m bone scanning in patients with pain in the knee region after cemented total knee arthroplasty. Eur J Orthop Surg Traumatol 29, 1105–1113 (2019). https://doi.org/10.1007/s00590-019-02407-5

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