Article

White blood cell scintigraphy for differentiation of infection and aseptic loosening - A retrospective study of 76 painful hip prostheses

Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, Copenhagen, Denmark.
Acta Orthopaedica (Impact Factor: 2.45). 11/2007; 78(5):640-7. DOI: 10.1080/17453670710014338
Source: PubMed

ABSTRACT Diagnosis of an infected arthroplasty is often difficult. Fever, abnormal physical findings, radiographic changes, findings at bone scintigraphy, an elevated erythrocyte sedimentation rate, CRP, and leucocytosis are not specific enough. We evaluated the diagnostic value of white blood cell scintigraphy.
We retrospectively reviewed 76 cases (66 patients) admitted for white blood cell scintigraphy with a clinical suspicion of infection in a hip prosthesis during the period 1995-2003. The leukocytes were labeled with (99m)Tc-HMPAO or with (111)In-oxin. Anterior and posterior views were taken of both hip joints at 3 different time points after injection: 1 h, 3 h, and 22 h. Infection was verified by means of bacteriological cultures, histopathological findings, intraoperative frozen sections, and follow-up (up to 3.5 years).
Of 76 scintigraphies, 51 were negative and 25 were positive. There were 81% true positive, 94% true negative, 6% false positive, and 19% false negative outcomes.
White blood cell scintigraphy with additional late imaging is an effective tool for differentiation between loosening and infection in painful hip arthroplasty.

0 Bookmarks
 · 
79 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The diagnosis of periprosthetic joint infection (PJI) remains a serious clinical challenge. There is a pressing need for improved diagnostic testing methods; biomarkers offer one potentially promising approach. We evaluated the diagnostic characteristics of 16 promising synovial fluid biomarkers for the diagnosis of PJI. Synovial fluid was collected from 95 patients meeting the inclusion criteria of this prospective diagnostic study. All patients were being evaluated for a revision hip or knee arthroplasty, including patients with systemic inflammatory disease and those already receiving antibiotic treatment. The Musculoskeletal Infection Society (MSIS) definition was used to classify 29 PJIs and 66 aseptic joints. Synovial fluid samples were tested by immunoassay for 16 biomarkers optimized for use in synovial fluid. Sensitivity, specificity, and receiver operating characteristic curve analysis were performed to assess for diagnostic performance. Five biomarkers, including human α-defensin 1-3, neutrophil elastase 2, bactericidal/permeability-increasing protein, neutrophil gelatinase-associated lipocalin, and lactoferrin, correctly predicted the MSIS classification of all patients in this study, with 100% sensitivity and specificity for the diagnosis of PJI. An additional eight biomarkers demonstrated excellent diagnostic strength, with an area under the curve of greater than 0.9. Synovial fluid biomarkers exhibit a high accuracy in diagnosing PJI, even when including patients with systemic inflammatory disease and those receiving antibiotic treatment. Considering that these biomarkers match the results of the more complex MSIS definition of PJI, we believe that synovial fluid biomarkers can be a valuable addition to the methods utilized for the diagnosis of infection. Level II, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 03/2014; 472(11). DOI:10.1007/s11999-014-3543-8 · 2.79 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although the International Consensus Meeting on Periprosthetic Joint Infection’s definition of periprosthetic joint infection (PJI) does not include nuclear imaging as part of the diagnostic criteria and the American Academy of Orthopaedic Surgeons’ clinical guidelines are not conclusive regarding its utility, many contemporary nuclear medicine studies are reporting exceptional predictive values and accuracy in the diagnosis of PJI. We conducted a systematic review of studies published from 2004 to 2012 reporting the accuracy of new technologies in nuclear medicine for diagnosis of PJI, utilizing a specially designed assessment tool (QUADAS-2) for critical appraisal and investigation of bias. Our results revealed high risk of bias as well as high levels of concern regarding the clinical applicability of these new diagnostic tests in a vast majority of the reviewed studies. On the basis of our findings, we recommend that the use of bone scan, an invasive and expensive technology, for diagnosis of PJI be limited to a few select cases.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: We conducted a study to assess the diagnostic accuracy of the C-reactive protein (CRP) assay for periprosthetic joint infection (PJI). Methods: For the purpose of the study, we conducted a search of PubMed, selecting only studies that described the diagnosis of PJI through measurement of the serum CRP concentration. The results were meta-analyzed by pooling estimates of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) and constructing respective summary receiver-operating characteristic (SROC) curves. We also conducted subgroup analyses according to cutoff values of the serum CTP concentration. Results: A total of 25 studies met the selection criteria for inclusion in the analysis. The pooled estimates for sensitivity, specificity, and the area under the curve (AUC) for the CRP assay were 0.82 (95% CI 0.80-0.84), 0.77 (95% CI 0.76-0.78), and 0.877±0.016, respectively. In the 10 mg/L cutoff subgroup, the pooled estimates for sensitivity, specificity, and the AUC were 0.881 (95% CI 0.859-0.901), 0.728 (95% CI 0.706-0.749), and 0.8496±0.0248, respectively. Conclusion: We found that the serum CRP assay had good diagnostic accuracy for PJI but that its specificity was low. We recommend that when the CRP assay yields a normal result, other tools be used adjunctively with it to reduce the rate of false-negative diagnoses of PJI.
    Surgical Infections 05/2014; 15(5). DOI:10.1089/sur.2013.066 · 1.72 Impact Factor

Preview

Download
0 Downloads