title: Bone scan usefulness in patients with painful hip or knee prosthesis: 10 situations that can cause pain, other than loosening and infection.
abstract: In recent years, with the higher median life expectancy, the number of hip and knee replacements has increased. Clinical examination and morphological studies are essential to evaluate patients with a painful arthroplasty. Nuclear medicine examinations also play an important role, their main usefulness being the exclusion of prosthesis complications. Nevertheless, conventional examinations, namely bone scan and white blood cell scintigraphy, can also identify complications, such as loosening and infection. This study describes the normal and pathologic patterns of a bone scan and exemplifies ten common situations that can cause pain in patients with hip or knee arthroplasty, other than loosening and infection, which can be disclosed on a bone scintigraphy. The ten situations that should be considered and looked for when analysing a bone scan are: referred pain, patellofemoral pain syndrome, fractures, fissures, abscess/haematoma, bone insert behaviour, heterotopic ossification, greater trochanter pseudarthrosis, osteoarthritis extension in a knee with an unicompartmental prosthesis, and systemic disease with bone involvement.
authors.affiliation: Nuclear Medicine Department, Instituto Português de Oncologia Francisco Gentil, E.P.E. Lisbon, Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal. sofiacarrilhovaz@gmail.com.
authors.forename: Sofia
authors.initials: S
authors.lastname: Vaz
authors.affiliation: Nuclear Medicine Department, Instituto Português de Oncologia Francisco Gentil, E.P.E. Lisbon, Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal.
authors.forename: Teresa C
authors.initials: TC
authors.lastname: Ferreira
authors.affiliation: Nuclear Medicine Department, Instituto Português de Oncologia Francisco Gentil, E.P.E. Lisbon, Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal.
authors.forename: Lucília
authors.initials: L
authors.lastname: Salgado
authors.affiliation: Nuclear Medicine Department, Hôpital Lariboisière Assistance Publique-Hôpitaux de Paris, rue Ambroise-Paré 75475, Paris Cedex 10, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Paycha
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary; D018786:Bone Substitutes / Q000009:adverse effects; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000145:classification; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D009999:Ossification, Heterotopic / Q000150:complications / Q000000981:diagnostic imaging; D020370:Osteoarthritis, Knee / Q000150:complications / Q000000981:diagnostic imaging; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000209:etiology*; D053591:Referred Pain / Q000000981:diagnostic imaging / Q000209:etiology; D046788:Patellofemoral Pain Syndrome / Q000000981:diagnostic imaging / Q000209:etiology; D057068:Periprosthetic Fractures / Q000150:complications / Q000000981:diagnostic imaging; D011475:Prosthesis Failure / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000150:complications / Q000000981:diagnostic imaging; D011542:Pseudarthrosis / Q000150:complications / Q000000981:diagnostic imaging; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods
chemical_list: D018786:Bone Substitutes
keywords: Arthroplasty; Bone SPECT/CT; Bone scan; Infection; Loosening; Painful prosthesis