The use of 99mTc-recombinant human annexin V imaging for differential diagnosis of aseptic loosening and low-grade infection in hip and knee prostheses.
The aim of this study was to assess the pattern of annexin V uptake in hip and knee prostheses suspected of being infected.


METHODS
A total of 7 patients undergoing revision surgery for hip or knee prostheses were studied; 5 patients had total hip replacements, and 2 had total knee replacements. Infection was confirmed by pathology, culture results, laboratory evaluation, and clinical follow-up. All patients also underwent a bone scan before surgery.


RESULTS
Annexin V scan findings were positive in 5 patients and negative in 2. Annexin V uptake was either focal (n = 4) or linear (n = 1). There were 4 true-positive, 2 true-negative, 1 false-positive, and no false-negative annexin V studies. Annexin V uptake was either more extensive or less extensive than, and usually was incongruent with, (99m)Tc-methylene diphosphonate uptake.


CONCLUSIONS
Our findings suggest that annexin V imaging shows greater uptake with infection than with aseptic loosening and has a high negative predictive value for prosthetic infection.
Lorberboym
Mordechai
M
Department of Nuclear Medicine of the Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. mvlorber@zahav.net.il
Feldbrin
Zeev
Z
Hendel
David
D
Blankenberg
Francis G
FG
Schachter
Pinhas
P
D000368:Aged; D000369:Aged, 80 and over; D017304:Annexin A5 / Q000493:pharmacokinetics; D001424:Bacterial Infections / Q000000981:diagnostic imaging* / Q000209:etiology / Q000378:metabolism; D003937:Diagnosis, Differential; D019544:Equipment Failure Analysis / Q000379:methods; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging* / Q000209:etiology; D007719:Knee Joint / Q000000981:diagnostic imaging; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D015609:Organotechnetium Compounds / Q000493:pharmacokinetics; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000209:etiology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D011994:Recombinant Proteins
D017304:Annexin A5; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D011994:Recombinant Proteins; C417036:technetium Tc 99m annexin V