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BioMed Research International
Volume 2013 (2013), Article ID 693436, 4 pages
http://dx.doi.org/10.1155/2013/693436
Clinical Study

The Diagnostic Accuracy of Radionuclide Arthrography for Prosthetic Loosening in Hip and Knee Arthroplasty

1Department of Orthopaedic Surgery, Royal Adelaide Hospital, Australia
2Department of Orthopaedics, University Hospital of South Manchester, M23 9LT, UK

Received 7 April 2013; Accepted 6 June 2013

Academic Editor: Nicholas Dunne

Copyright © 2013 Timothy H. French et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose of Study. Diagnosis of prosthetic loosening in hip and knee arthroplasty remains a challenge. Although there are a number of diagnostic tools, no single test or combination is 100% sensitive or specific. There has been a recent interest in the use of radionuclide arthrography (RNA) for detection of prosthetic loosening. Methods. A retrospective review of 45 consecutive RNA scans from 2005 to 2010 was conducted. RNA findings were compared with intraoperative findings at revision and/or serial radiographic examinations to confirm loosening. A component was considered loose if sequential radiographs demonstrated macromotion, gross subsidence, or progressive radiolucency. Results. There were 26 females and 17 males, with mean age at RNA of 71 years (range of 53–89 years) and mean time from index surgery, 6.4 years (range of 0.5–23 years). There were 23 total knee replacements (TKR) (19 primary and 4 revision) and 20 total hip replacements (THR) (11 primary and 9 revision). 15 patients underwent revision surgery following RNA. Strict inclusion criteria allowed 27 patients for further analysis. Sixteen RNA scans were suggestive of loosening, of which 14 were confirmed loose. Eleven scans were suggestive of a stable prosthesis, of which 10 were confirmed well fixed. RNA had a sensitivity of 93%, specificity of 83%, positive predictive value of 88%, and negative predictive value of 91%. Conclusion. Radionuclide arthrography should be considered a useful adjunct in the diagnosis of prosthetic loosening in the challenging patient.