Chinese Journal of Tissue Engineering Research ›› 2010, Vol. 14 ›› Issue (17): 3041-3045.doi: 10.3969/j.issn.1673-8225.2010.17.001

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Clinical significance of triple-phase bone scintigraphy in diagnosing peri-prosthetic infection following hip arthroplasty 

Zhang Jiong, Feng Jian-min, Wang Yi, Yang Qing-ming, Liu Zhi-hong, He Chuan   

  1. Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai  200025, China
  • Online:2010-04-23 Published:2010-04-23
  • Contact: Feng Jian-min, Chief physician, Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200025, China fengjm@shtel.net.cn
  • About author:Zhang Jiong, Attending physician, Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200025, China zj10921@msn.com

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Abstract:

BACKGROUND: Aseptic loosening and infection are difficult to diagnose due to their similar clinical manifestations following total hip replacement. There lacks routine examinations or gold standard to diagnose peri-prosthetic infection.
OBJECTIVE: To evaluate the clinical effectiveness of technetium-99m-labelled triphase isotope scinitigraphy in the diagnosis of peri-prosthetic infection following total hip arthroplasty.
METHODS: A total of 11 patients with suspected peri-prosthetic infection were selected, with continuous hip pain, prosthesis loosening and abnormal serum indexes, including 7 males and 4 females, with an average age of 63.8 (53-74) years. The average time of prosthesis usage was 14.5 (0.5-30) years. The technetium 99m-labelled bone scintigraphy images were obtained to observe the density variation of the infection region during the blood flow phase, blood pool phase and late phase and compared with normal lateral limb. Time-radioactive uptake curve was made using software to analyze the diagnostic results. In addition, the diagnostic value of the triple-phase bone scinitigraphy was analyzed using the intraoperative frozen section results (neutrophil < 5 under 10 high power visual fields: no infection).
RESULTS AND CONCLUSION: Of 11 patients, 2 cases showed negative result of triple-phase bone scinitigraphy, and intraoperative frozen section analysis showed < 5 polymorphonuclear cells per high-power field, who underwent one-stage revision surgery; 8 displayed positive result of triple-phase bone scinitigraphy, and intraoperative frozen section analysis showed > 5 polymorphonuclear cells per high-power field, who underwent two-stage revision surgery; 1 case showed negative result of triple-phase bone scinitigraphy but intraoperative frozen section analysis showed > 5 polymorphonuclear cells per high-power field, who also underwent two-stage revision surgery. Results show that positive results of triple-phase bone scintigraphy were related to peri-prosthetic infection, which has great value for revision surgery in combination with histopathological examination.

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