Diagnostic accuracy and interobserver variability of plain radiography, subtraction arthrography, nuclear arthrography, and bone scintigraphy in the assessment of aseptic femoral component loosening.
BACKGROUND
Plain radiography, subtraction arthrography, nuclear arthrography, and bone scintigraphy are imaging techniques commonly used to identify aseptic femoral component loosening. Controversy exists about the relative utility of these techniques.


METHODS
We evaluated the diagnostic accuracy and interobserver reliability of the four techniques in 78 consecutive patients (mean age 70 years, range 29-88 years) referred for evaluation of their femoral hip prostheses. The standard evaluation protocol consisted of plain radiography followed by subtraction arthrography, nuclear arthrography, and bone scintigraphy. Surgery or the subsequent clinical course of the patient was used as gold standard.


RESULTS
Overall, plain radiography had a sensitivity and specificity of 81 and 74%, respectively. Subtraction arthrography had a sensitivity of 47% and a specificity of 78%. Nuclear arthrography had a sensitivity of 69% and a specificity of 76%, and bone scintigraphy had a sensitivity of 88% with a specificity of 50%.


CONCLUSIONS
We found considerable interobserver variability in all four techniques. Multivariate regression analysis revealed that bone scintigraphy and nuclear arthrography together made a significant contribution to the diagnosis when used in combination with plain radiography and are, when plain radiography is inconclusive, useful additional diagnostic techniques for the detection of femoral component loosening.
Department of Nuclear Medicine, VU University Medical Centre, Boelelaan 1117, 1007, Amsterdam, The Netherlands. opp.temmerman@vumc.nl
Olivier P P
OP
Temmerman
Pieter G H M
PG
Raijmakers
Johannes
J
Berkhof
Erik F L
EF
David
Rik
R
Pijpers
Marinus A
MA
Molenaar
Otto S
OS
Hoekstra
Gerrit J J
GJ
Teule
Ide C
IC
Heyligers
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001175:Arthrography / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate
D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate