SPECT-CT may aid in determining which side of a revision stemmed implant problematic total knee replacement is loose when planning revision surgery

IF 1.6 4区医学 Q3 ORTHOPEDICS Knee Pub Date : 2024-11-25 DOI:10.1016/j.knee.2024.10.016

Daniel Hill, Patrick Rogers, Jonathan Phillips, Ben Waterson, Andrew D. Toms

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Abstract

Aim

To evaluate SPECT-CT in the diagnosis of single component aseptic loosening in patients with a problematic cemented stemmed TKR (Total Knee Replacement).

Methods

SPECT-CT was performed where aseptic loosening was suspected but was not clear on plain radiography. Demographics, suspected diagnosis and intention to revise were collected prospectively before and after SPECT-CT.

Results

30 patients were investigated. 43% (95% CI: 0.5–0.9) had clear evidence of loosening on SPECT-CT. In 23% (95% CI: 0.1–0.4) intention to perform revision surgery following SPECT-CT changed (7/30) (p = 0.0004, standard error = 42.1, z = 3.5).

Intentions to perform revision surgery according to the radiologist’s overall summary were:

Normal SPECT-CT – 0% (95% CI: 0.0–0.8) intention to revise (0/2).

Possibly abnormal SPECT-CT – 13% (95% CI: 0.0–0.4) intention to revise (2/15).

Definitely abnormal SPECT-CT – 77% (95% CI: 0.5–0.9) intention to revise (10/13).

We report that SPECT-CT had a test sensitivity of 90.9% (95% CI: 0.6–1.0), a specificity of 100% (95% CI: 0.9–1.0), a positive predictive value of 100% and a negative predictive value of 97.7%.

In 70% (95% CI: 0.3–0.9) of cases where revision surgery was performed for aseptic loosening SPECT-CT provided information that guided pre-operative planning with regards single component or both component revision surgery (7/10).

CONCLUSION

When positive SPECT-CT was useful in determining single component revision. A normal SPECT-CT may have a negative predictive value; however, overall half of our series had a possibly abnormal or equivocal investigation.

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在计划翻修手术时，SPECT-CT 可帮助确定翻修干式植入物问题全膝关节置换术哪一侧松动

目的评估SPECT-CT在诊断有问题的骨水泥柄全膝关节置换术（TKR）患者单个组件无菌性松动中的作用。在 SPECT-CT 前后，前瞻性地收集了患者的人口统计学资料、疑似诊断和复查意向。43%（95% CI：0.5-0.9）的患者在 SPECT-CT 上有明确的松动证据。23%（95% CI：0.1-0.4）的患者（7/30）在SPECT-CT检查后进行翻修手术的意向发生了变化（p = 0.0004，标准误差 = 42.1，z = 3.5）。根据放射科医生的总体总结，进行翻修手术的意向为：SPECT-CT检查正常 - 0%（95% CI：0.SPECT-CT可能异常--13%（95% CI：0.0-0.4）有修改意向（2/15）.SPECT-CT肯定异常--77%（95% CI：0.5-0.9）有修改意向（10/13）。我们报告称，SPECT-CT 的检测灵敏度为 90.9%（95% CI：0.6-1.0），特异性为 100%（95% CI：0.9-1.0），阳性预测值为 100%，阴性预测值为 97.7%。在70%（95% CI：0.3-0.9）因无菌性松动而进行翻修手术的病例中，SPECT-CT提供的信息可指导单个组件或两个组件翻修手术的术前计划（7/10）。正常的SPECT-CT可能具有阴性预测价值；但是，在我们的系列研究中，有一半的研究结果可能异常或不明确。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.