title: An evaluation of the role of nuclear medicine imaging in the diagnosis of periprosthetic infections of the hip.
abstract: OBJECTIVE
  To validate the role of nuclear medicine (NM) imaging in hip periprosthetic joint infection (PJI) of hip arthroplasties.
  
  
  METHODS
  This was a retrospective study of 235 consecutive patients referred to NM for investigation of a symptomatic hip prosthesis. Imaging comprised Tc-99m bone scintigraphy, In-111 white cell scintigraphy, and bone marrow scintigraphy if required. Imaging findings were compared with intraoperative microbiology and histology, clinical findings and follow up for ≥ 24 months.
  
  
  RESULTS
  There were 14 exclusions. Of the 221 remaining patients, there were 16 true positives, one false positive, 200 true negatives, and four false negatives. The algorithm used at this centre demonstrated an accuracy of 97.7% with high specificity of 99.5% and sensitivity of 80%.
  
  
  CONCLUSIONS
  When modern NM techniques and accurate reporting criteria are used, scintigraphy is an effective tool for diagnosing PJI of the hip. NM is only given a marginal role in the recent American Association of Orthopedic Surgeons guidelines, and the orthopaedic community should reconsider their evaluation of this technique.
authors.affiliation: Medical Physics, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, UK. Electronic address: ctrevail@nhs.net.
authors.forename: C
authors.initials: C
authors.lastname: Trevail
authors.affiliation: Orthopaedics, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, UK.
authors.forename: P
authors.initials: P
authors.lastname: Ravindranath-Reddy
authors.affiliation: Nuclear Medicine, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, UK.
authors.forename: T
authors.initials: T
authors.lastname: Sulkin
authors.affiliation: Orthopaedics, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, UK.
authors.forename: G
authors.initials: G
authors.lastname: Bartlett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate / Q000031:analogs & derivatives; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015415:Biomarkers; D019275:Radiopharmaceuticals; C024226:technetium Tc 99m hydroxymethylene diphosphonate; D013669:Technetium Tc 99m Medronate