title: Sequential indium-labeled leukocyte and bone scans to diagnose prosthetic joint infection.
abstract: Previous studies suggest that sequential technetium-99-hydroxymethyl diphosphonate bone scanning and indium-111 leukocyte scintigraphy may play a role during revision arthroplasty. Preoperative sequential imaging was compared with joint aspiration and clinical assessment during revision knee or hip arthroplasty. Scans were considered positive if indium-111 leukocyte uptake was incongruent or focally more intense than that of technetium-99-hydroxymethyl diphosphonate uptake. Of 166 cases, 22 were infected. Sequential technetium-99-hydroxymethyl diphosphonate and indium-111 leukocyte imaging was 64% sensitive and 78% specific. Fever, physical findings, or sedimentation rate did not identify infection reliably, and preoperative aspirate culture was only 28% sensitive. Positive scintigraphy increased the likelihood of finding infection intraoperatively from 14% to 30%, although negative scintigraphy decreased this likelihood to 7%. Based on the current study, the routine use of sequential technetium-99-hydroxymethyl diphosphonate and indium-111 leukocyte imaging cannot be advocated for differentiating occult infection from mechanical failure in painful, loose total joint arthroplasties.
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Teller
authors.forename: M J
authors.initials: MJ
authors.lastname: Christie
authors.forename: W
authors.initials: W
authors.lastname: Martin
authors.forename: E P
authors.initials: EP
authors.lastname: Nance
authors.forename: D W
authors.initials: DW
authors.lastname: Haas
mesh_terms: D001431:Bacteriological Techniques; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D007720:Knee Prosthesis; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D015125:Oxyquinoline / Q000031:analogs & derivatives; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000601:surgery; D011877:Radionuclide Imaging; D012086:Reoperation; D013669:Technetium Tc 99m Medronate / Q000031:analogs & derivatives
chemical_list: D009942:Organometallic Compounds; C032950:indium oxine; D015125:Oxyquinoline; C024226:technetium Tc 99m hydroxymethylene diphosphonate; D013669:Technetium Tc 99m Medronate