title: Clinical value of SPECT/CT in the painful total knee arthroplasty (TKA): a prospective study in a consecutive series of 100 TKA.
abstract: OBJECTIVE
  Bone single photon emission computed tomography (SPECT)/CT is considered as beneficial in unhappy patients with pain, stiffness or swelling after total knee arthroplasty (TKA). The purpose of this study was to identify typical patterns of bone tracer uptake (BTU), distribution and intensity values in patients after TKA. The above findings were correlated with the type and fixation of TKA, the time from TKA and intraoperative findings at revision surgery.
  
  
  METHODS
  A total of 100 knees of 84 consecutive patients (mean age ± SD 70 ± 11 years) after TKA with persistent knee pain were prospectively included. All patients underwent clinical examination, standardized radiographs and (99m)Tc-hydroxymethane diphosphonate (HDP) SPECT/CT as part of a routine diagnostic algorithm. The diagnosis before and after SPECT/CT and final treatment were recorded. TKA component position was determined on 3-D reconstructed images. Intensity and anatomical distribution of BTU was determined. Maximum intensity values were recorded as well as ratios in relation to the proximal midshaft of the femur. Univariate analyses (chi-square test, Pearson's correlation and t test for independent samples) were performed (p < 0.05).
  
  
  RESULTS
  SPECT/CT changed the clinical diagnosis and final treatment in 85/100 (85 %) knees. Intraoperative findings confirmed the preoperative SPECT/CT diagnosis in 32/33 knees (97 %). TKA loosening as well as progression of patellofemoral osteoarthritis (OA) was correctly diagnosed in 100 % of knees. Typical patterns of BTU for specific pathologies were identified. Loose femoral TKA components significantly correlated with increased BTU at the lateral femoral regions (p < 0.05). Loose tibial TKA components significantly correlated with increased BTU at all tibial regions (p < 0.05) and around the tibial peg (p > 0.01).
  
  
  CONCLUSIONS
  The diagnostic benefits of SPECT/CT in patients after TKA have been proven. Typical pathology-related BTU patterns were identified, which will improve reporting quality. Due to the benefits in establishing the correct diagnosis, SPECT/CT should be part of the routine diagnostic algorithm for patients with pain after TKA.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. Michael.Hirschmann@unibas.ch.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Hirschmann
authors.affiliation: Amsler Consulting, Basel, Switzerland.
authors.forename: Felix
authors.initials: F
authors.lastname: Amsler
authors.affiliation: Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland, 4101, Bruderholz, Switzerland.
authors.forename: Helmut
authors.initials: H
authors.lastname: Rasch
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D064847:Multimodal Imaging; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000209:etiology; D010146:Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D057071:Patellofemoral Joint / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011475:Prosthesis Failure / Q000209:etiology; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000209:etiology; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
keywords: Bone; CT; Component position; Knee; Replacement; SPECT; SPECT/CT; Total knee arthroplasty; Tracer uptake