Detection of aseptic loosening in total knee replacements: a systematic review and meta-analysis

  • Lara BarnsleyEmail author
  • Les Barnsley
Scientific Article



The aim of this study was to compare the diagnostic accuracy of nuclear imaging modalities in the detection of aseptic loosening of total knee arthroplasty (TKA).

Materials and methods

MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched from database inception to December 2018 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies compared the results of a single imaging modality against an appropriate reference standard of prosthetic TKA loosening, with sufficient information to determine either sensitivity and/or specificity. The methodological quality of the studies was assessed using the QUADAS-2 tool.


The search strategy identified 572 abstracts. Of these, 12 studies comprising 401 patients across four modalities (bone scintigraphy, 18F-FDG-PET, SPECT/CT arthrogram, radionuclide arthrogram) met the inclusion criteria. All included studies used operative findings, a period of clinical or radiographic observation or both as a reference standard for aseptic loosening. Sixteen comparisons with the reference standards were extracted. All studies were at risk of bias across patient selection, the index test, reference standard, and flow and timing of patients. The most accurate test for diagnosis of aseptic loosening in TKA was SPECT/CT arthrography demonstrated by the summary receiver operating characteristic curve.


The best available evidence suggests the most accurate modality for the detection of aseptic loosening in TKA is SPECT/CT arthrography. However, the available evidence has a high risk of bias, and total number of patients studied for each modality is small so further studies are warranted.


Meta-analysis Total knee arthroplasty Nuclear medicine Prosthesis loosening Sensitivity Specificity 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

256_2019_3215_MOESM1_ESM.docx (13 kb)
ESM 1 (DOCX 13 kb)


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Copyright information

© ISS 2019

Authors and Affiliations

  1. 1.Orthopaedic DepartmentWestern HealthFootscrayAustralia
  2. 2.Department of MedicineUniversity of SydneySydneyAustralia
  3. 3.Department of RheumatologyConcord HospitalConcordAustralia

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