title: Use of positron emission tomography to detect infection around antibiotic-loaded cement spacers in patients with high C-reactive protein levels.
abstract: In patients who have antibiotic-loaded cement hip spacers in the interim period, the correct diagnosis of infection eradication is the major determinant before reimplantation arthroplasty. Diagnosis is usually based on clinical findings and serum C-reactive protein (CRP) levels. However, diagnosis can be challenging when the clinical findings are normal but the CRP level is high. From March 2007 to January 2008, fluorodeoxy-glucose positron emission tomography (FDG-PET) was used to detect infection around antibiotic-loaded cement spacers in 13 patients (mean age, 60 years). Although patients' clinical conditions were deemed suitable for reimplantation, their serum CRP levels were persistently elevated (mean, 54 mg/L) an average of 120 days (range, 28-413 days) after the first-stage operation. Reimplantation total hip arthroplasty (THA) was subsequently performed in 7 patients based on the negative findings of FDG-PET. In 6 patients, FDG-PET was positive for infection. The persistence of infection was confirmed in 3 of these patients by another debridement surgery. Staged reimplantation THA was delayed in 1 patient who underwent repeat debridement and in 3 patients who were treated with extended periods of oral antibiotics. Of the 11 staged reimplantation THAs, only 1 reinfection was noted at an average follow-up of 48 months. The success rate of 91% suggests FDG-PET could help in the differential diagnosis of infection around cement spacers, especially in patients with normal clinical findings but elevated CRP levels.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan, Republic of China.
authors.forename: Ming-Jhe
authors.initials: MJ
authors.lastname: Huang
authors.forename: Pang-Hsin
authors.initials: PH
authors.lastname: Hsieh
authors.forename: Steve W N
authors.initials: SW
authors.lastname: Ueng
authors.forename: Kung-Chu
authors.initials: KC
authors.lastname: Ho
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
authors.forename: Mel S
authors.initials: MS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D001843:Bone Cements; D002097:C-Reactive Protein / Q000032:analysis; D003646:Debridement; D005260:Female; D019788:Fluorodeoxyglucose F18; D006621:Hip Joint; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D019788:Fluorodeoxyglucose F18; D002097:C-Reactive Protein