FDG-PET/CT Whole Body Stumpe et al [79] found diffuse synovial and focal extrasynovial FDG uptake in patients with component malrotation; however, FDG-PET/CT studies are not routinely used for the assessment of rotational alignment of a TKA. Fluoride PET/CT Whole Body There is insufficient evidence to support the use of fluoride PET/CT for the assessment of rotational alignment of a TKA. Fluoroscopy Knee There is insufficient evidence to support the use of fluoroscopy for the assessment of rotational alignment of a TKA. MRI Knee Without and With IV Contrast IV contrast is not useful for MRI assessment of rotational alignment. MRI Knee Without IV Contrast When adequate metal reduction techniques are used, MRI can be used to assess TKA component rotation [146]. Anatomic landmarks and axes required for measurement of rotational alignment parameters can be identified [147,148]. In a study of 50 patients with painful TKA and 16 controls, Murakami et al [148] found high interobserver agreement in all the relevant rotational alignment measurements and found statistically significant relative internal rotation of the femoral component in patients with a painful TKA. MRI literature is evolving, and the available evidence suggests MRI may be useful in the assessment of component rotation with adequate metal reduction techniques. US Knee There is insufficient evidence to support the use of US for the assessment of rotational alignment of a TKA. WBC Scan and Sulfur Colloid Scan Knee There is insufficient evidence to support the use of In-111 WBC and Tc-99m sulfur colloid studies for the assessment of rotational alignment of a TKA. Variant 6: Pain after total knee arthroplasty. Suspect periprosthetic soft-tissue abnormality unrelated to infection, including quadriceps or patellar tendinopathy (quadriceps or patellar tendon tears, postoperative arthrofibrosis, patellar clunk syndrome, or impingement of nerves or other soft tissues). Additional imaging following radiographs.
Imaging After Total Knee Arthroplasty. FDG-PET/CT Whole Body Stumpe et al [79] found diffuse synovial and focal extrasynovial FDG uptake in patients with component malrotation; however, FDG-PET/CT studies are not routinely used for the assessment of rotational alignment of a TKA. Fluoride PET/CT Whole Body There is insufficient evidence to support the use of fluoride PET/CT for the assessment of rotational alignment of a TKA. Fluoroscopy Knee There is insufficient evidence to support the use of fluoroscopy for the assessment of rotational alignment of a TKA. MRI Knee Without and With IV Contrast IV contrast is not useful for MRI assessment of rotational alignment. MRI Knee Without IV Contrast When adequate metal reduction techniques are used, MRI can be used to assess TKA component rotation [146]. Anatomic landmarks and axes required for measurement of rotational alignment parameters can be identified [147,148]. In a study of 50 patients with painful TKA and 16 controls, Murakami et al [148] found high interobserver agreement in all the relevant rotational alignment measurements and found statistically significant relative internal rotation of the femoral component in patients with a painful TKA. MRI literature is evolving, and the available evidence suggests MRI may be useful in the assessment of component rotation with adequate metal reduction techniques. US Knee There is insufficient evidence to support the use of US for the assessment of rotational alignment of a TKA. WBC Scan and Sulfur Colloid Scan Knee There is insufficient evidence to support the use of In-111 WBC and Tc-99m sulfur colloid studies for the assessment of rotational alignment of a TKA. Variant 6: Pain after total knee arthroplasty. Suspect periprosthetic soft-tissue abnormality unrelated to infection, including quadriceps or patellar tendinopathy (quadriceps or patellar tendon tears, postoperative arthrofibrosis, patellar clunk syndrome, or impingement of nerves or other soft tissues). Additional imaging following radiographs.