Additional imaging following radiographs. Ong et al [74] found the incidence of infection after THA in the Medicare population for 1997 and 2006 to be 1.63% within 2 years and 0.59% between 2 and 10 years. The identification of periprosthetic infection is critical to choosing appropriate treatment but diagnosis can be challenging [75]. Guidelines for patient evaluation have been developed [76]. A definition of periprosthetic infection has been proposed by the musculoskeletal infection society that includes major and minor criteria but not specifically imaging criteria [75]. Bone Scan and Gallium Scan Hip The most recent data on bone and gallium scans for diagnosing periprosthetic hip infection are more than 25 years old because this test has been largely replaced by labeled leukocyte and marrow imaging and FDG-PET [77-79]. Bone Scan and Gallium Scan with SPECT or SPECT/CT Hip There is no relevant literature to support the use of bone and gallium scan with SPECT or SPECT/CT of the hip as these tests have been replaced by leukocyte and bone marrow imaging and FDG-PET for diagnosing periprosthetic hip infection. Bone Scan Hip Bone scan of the hip is sensitive but not specific for periprosthetic hip infection. Performing the test as a 3-phase bone scan does not improve accuracy, with reported sensitivity and specificity ranging from 29% to 88% and 50% to 92%, respectively [61,80-82]. Bone Scan with SPECT or SPECT/CT Hip Schweizer et al [83] retrospectively studied 58 total hip prostheses, including 31 symptomatic and 27 asymptomatic prostheses, with bone scan with SPECT/CT. SPECT/CT identified the cause of pain in 19 (61%) of the 31 symptomatic devices. No pathology-specific uptake pattern was observed. Although periprosthetic uptake was significantly higher in symptomatic individuals than in asymptomatic individuals, a normal result did not exclude pathology.
Imaging after Total Hip Arthroplasty PCAs. Additional imaging following radiographs. Ong et al [74] found the incidence of infection after THA in the Medicare population for 1997 and 2006 to be 1.63% within 2 years and 0.59% between 2 and 10 years. The identification of periprosthetic infection is critical to choosing appropriate treatment but diagnosis can be challenging [75]. Guidelines for patient evaluation have been developed [76]. A definition of periprosthetic infection has been proposed by the musculoskeletal infection society that includes major and minor criteria but not specifically imaging criteria [75]. Bone Scan and Gallium Scan Hip The most recent data on bone and gallium scans for diagnosing periprosthetic hip infection are more than 25 years old because this test has been largely replaced by labeled leukocyte and marrow imaging and FDG-PET [77-79]. Bone Scan and Gallium Scan with SPECT or SPECT/CT Hip There is no relevant literature to support the use of bone and gallium scan with SPECT or SPECT/CT of the hip as these tests have been replaced by leukocyte and bone marrow imaging and FDG-PET for diagnosing periprosthetic hip infection. Bone Scan Hip Bone scan of the hip is sensitive but not specific for periprosthetic hip infection. Performing the test as a 3-phase bone scan does not improve accuracy, with reported sensitivity and specificity ranging from 29% to 88% and 50% to 92%, respectively [61,80-82]. Bone Scan with SPECT or SPECT/CT Hip Schweizer et al [83] retrospectively studied 58 total hip prostheses, including 31 symptomatic and 27 asymptomatic prostheses, with bone scan with SPECT/CT. SPECT/CT identified the cause of pain in 19 (61%) of the 31 symptomatic devices. No pathology-specific uptake pattern was observed. Although periprosthetic uptake was significantly higher in symptomatic individuals than in asymptomatic individuals, a normal result did not exclude pathology.