title: Hybrid SPECT/CT for the assessment of a painful hip after uncemented total hip arthroplasty.
abstract: BACKGROUND
  The diagnosis of hip pain after total hip replacement (THR) represents a highly challenging question that is of increasing concern to orthopedic surgeons. This retrospective study assesses bone scintigraphy with Hybrid SPECT/CT for the diagnosis of painful THR in a selected cohort of patients.
  
  
  METHODS
  Bone SPECT/CT datasets of 23 patients (mean age 68.9 years) with a painful hip after THR were evaluated. Selection of the patients required an inconclusive radiograph, normal serum levels of inflammatory parameters (CRP and ESR) or a negative aspiration of the hip joint prior to the examination. The standard of reference was established by an interdisciplinary adjudication-panel using all imaging data and clinical follow-up data (>12 month). Pathological and physiological uptake patterns were defined and applied.
  
  
  RESULTS
  The cause of pain in this study group could be determined in 18 out of 23 cases. Reasons were aseptic loosening (n = 5), spine-related (n = 5), heterotopic ossification (n = 5), neuronal (n = 1), septic loosening (n = 1) and periprosthetic stress fracture (n = 1). In (n = 5) cases the cause of hip pain could not be identified. SPECT/CT imaging correctly identified the cause of pain in (n = 13) cases, in which the integrated CT-information led to the correct diagnosis in (n = 4) cases, mainly through superior anatomic correlation. Loosening was correctly assessed in all cases with a definite diagnosis.
  
  
  CONCLUSIONS
  SPECT/CT of THA reliably detects or rules out loosening and provides valuable information about heterotopic ossifications. Furthermore differential diagnoses may be detected with a whole-body scan and mechanical or osseous failure is covered by CT-imaging. SPECT/CT holds great potential for imaging-based assessment of painful prostheses.
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. o.dobrindt@gmail.com.|Charité - Universitätsmedizin, Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charitéplatz 1, 10117, Berlin, Germany. o.dobrindt@gmail.com.
authors.forename: Oliver
authors.initials: O
authors.lastname: Dobrindt
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. holger.amthauer@med.ovgu.de.
authors.forename: Holger
authors.initials: H
authors.lastname: Amthauer
authors.affiliation: Orthopädische Universitätsklinik, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. alexander.krueger@med.ovgu.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Krueger
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. juri.ruf@uniklinik-freiburg.de.|Universitätsklinikum Freiburg, Klinik für Nuklearmedizin, Hugstetter Straße 55, 79106, Freiburg, Germany. juri.ruf@uniklinik-freiburg.de.
authors.forename: Juri
authors.initials: J
authors.lastname: Ruf
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. heiko.wissel@med.ovgu.de.
authors.forename: Heiko
authors.initials: H
authors.lastname: Wissel
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. oliver.grosser@med.ovgu.de.
authors.forename: Oliver S
authors.initials: OS
authors.lastname: Grosser
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. max.seidensticker@med.ovgu.de.
authors.forename: Max
authors.initials: M
authors.lastname: Seidensticker
authors.affiliation: Orthopädische Universitätsklinik, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. christoph.lohmann@med.ovgu.de.
authors.forename: Christoph H
authors.initials: CH
authors.lastname: Lohmann
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000175:diagnosis* / Q000209:etiology*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001843:Bone Cements; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements