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Nuklearmedizinische Diagnostik bei schmerzhafter Knieprothese

Nuclear medical imaging in case of painful knee arthroplasty

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Zusammenfassung

Hintergrund

Ziel der vorliegenden Studie war die Bewertung der diagnostischen Treffsicherheit nuklearmedizinischer Untersuchungstechniken bei Patienten mit schmerzhafter Knieprothese.

Material und Methoden

Zwischen 2003 und 2007 wurden 87 Patienten mit schmerzhafter Knieprothese sowohl mit der 99mTc-Dreiphasenskelettszintigraphie (99mTc-Dreiphasen-DPD; n=120) als auch mit 99mTc-anti-Granulozyten-Antikörpern (Behring-Werke 250/183; n=20) untersucht.

Ergebnisse

Ausgewertet wurden 87 Patienten mit 94 Knieprothesen mit Verdacht auf septische Prothesenlockerung. Sensitivität, Spezifität, positiver und negativer prädiktiver Wert sowie die diagnostische Genauigkeit mit der 99mTc-Dreiphasen-DPD zur Unterscheidung zwischen septischer und aseptischer Knieprothesenlockerung betrugen 100, 85, 55, 100, 73 und bei BW 250/183 91, 66, 76, 85, 80%. Ein signifikanter Zugewinn an diagnostischer Genauigkeit mit entsprechend 94, 88, 89, 95 und 89% (p <0,001) konnte erreicht werden, wenn beide Methoden kombiniert ausgewertet wurden.

Schlussfolgerung

Beide Methoden alleine haben einen hohen negativen prädiktiven Aussagewert, aber die Kombination beider Methoden ergänzen sich, sodass ein signifikanter Zugewinn an diagnostischer Genauigkeit und positivem prädiktivem Aussagewert zum spezifischen Nachweis einer Knieprothesenlockerung erreicht werden kann.

Abstract

Rationale

The aim of the present study was to calculate the overall diagnostic accuracy of nuclear medical imaging in patients with painful knee arthroplasty.

Material and methods

This retrospective study of all patients (n=87) where a 99mTc-triple phase bone scintigraphy (TPBS; n=120) and 99mTc-anti-granulocyte scintigraphy (BW 250/183; n=20) for a painful knee arthroplasty was performed between 2003 and 2007.

Results

A total of 87 patients with 94 knee arthroplasties were examined to detect septic and aseptic loosening and to differentiate between them. The sensitivity, specificity, the positive and negative predictive value and accuracy of TPBS for the detection of septic knee arthroplasty loosening was 100%, 85%, 55%, 100%, 73% and for BW 250/183 was 91%, 66%, 76%, 85%, 80% for sepsis, respectively. A significant increase in diagnostic accuracy with 94%, 88%, 89%, 95% und 89% (p <0.001) could be achieved when both methods were used in combination.

Conclusion

Both methods alone have high negative predictive values, but the combination of both is complementary and significantly increases the diagnostic accuracy and positive predictive value for final diagnosis of knee arthroplasty loosening.

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Authors and Affiliations

  1. Abteilung für Nuklearmedizin, Philipps-Universität, Marburg, Deutschland

    S. Gratz, H. Höffken & T.M. Behr

  2. Abteilung für Orthopädie und Unfallchirurgie, Klinikum Bad Cannstatt, Stuttgart, Deutschland

    H. Strosche & P. Reize

  3. Praxis für Nuklearmedizin und Radiologie, Seelbergstr. 11, 70372, Stuttgart, Deutschland

    S. Gratz & J.W. Kaiser

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  1. S. Gratz
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  2. H. Höffken
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  3. J.W. Kaiser
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  4. T.M. Behr
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  5. H. Strosche
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  6. P. Reize
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Correspondence to S. Gratz.

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Gratz, S., Höffken, H., Kaiser, J. et al. Nuklearmedizinische Diagnostik bei schmerzhafter Knieprothese. Radiologe 49, 59–67 (2009). https://doi.org/10.1007/s00117-008-1703-0

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