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

  • Lara BarnsleyEmail author
  • Les Barnsley
Scientific Article
  • 31 Downloads

Abstract

Objective

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.

Results

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.

Conclusions

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.

Keywords

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

Notes

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)

References

  1. 1.
    Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster J-Y. Health-related quality of life in total hip and total knee arthroplasty: a qualitative and systematic review of the literature. J Bone Joint Surg. 2004;86(5):963–74.CrossRefGoogle Scholar
  2. 2.
    Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty: 2018 Annual Report. Adelaide: AOA.Google Scholar
  3. 3.
    Broughton N, Collopy D, Solomon M. Arthroplasty Society of Australia position statement on follow-up of joint replacement patients. Australian Orthopaedic Association; 2016.Google Scholar
  4. 4.
    Abu-Amer Y, Darwech I, Clohisy JC. Aseptic loosening of total joint replacements: mechanisms underlying osteolysis and potential therapies. Arthritis Res Ther. 2007;9(Suppl 1):S6.CrossRefGoogle Scholar
  5. 5.
    Mandalia V, Eyres K, Schranz P, Toms A. Evaluation of patients with a painful total knee replacement. J Bone Joint Surg (Br). 2008;90(3):265–71.CrossRefGoogle Scholar
  6. 6.
    Hirschmann MT, Konala P, Iranpour F, Kerner A, Rasch H, Friederich NF. Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty—a new dimension of diagnostics? BMC Musculoskelet Disord. 2011;12(36).Google Scholar
  7. 7.
    Dennis DA. Evaluation of painful total knee arthroplasty. J Arthroplast. 2004;19(4 (Suppl 1)):35–40.CrossRefGoogle Scholar
  8. 8.
    Reinartz P. FDG-PET in patients with painful hip and knee arthroplasty: technical breakthrough or more of the same. Q J Nucl Med Mol Imaging. 2009;53(1):41–50.Google Scholar
  9. 9.
    Love C, Marwin SE, Palestro CJ. Nuclear medicine and the infected joint replacement. Semin Nucl Med. 2009;39:66–78:66-78.CrossRefGoogle Scholar
  10. 10.
    Palestro C. Nuclear medicine and the failed joint replacement: past, present, and future. World J Radiol. 2014;6(7):446–58.CrossRefGoogle Scholar
  11. 11.
    Sneag DB, Bogner EA, Potter HG. Magnetic resonance imaging evaluation of the painful total knee arthroplasty. Semin Musculoskelet Radiol. 2015;19:40–8.CrossRefGoogle Scholar
  12. 12.
    Solomon L, Stamenkov R, MacDonald A, Yaikwavong N, Neale S, Moss M, et al. Imaging peri-prosthetic osteolysis around total knee arthroplasties using a human cadaver model. J Arthroplast. 2012;27(6):1069–74.CrossRefGoogle Scholar
  13. 13.
    Moher D, Liberati A, Tetzlaff J, Altman D, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefGoogle Scholar
  14. 14.
    de Vet H, Eisinga A, Riphagen I, Aertgeerts B, Pewsner D. Chapter 7: searching for Studies. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 04: The Cochrane Collaboration; 2008.Google Scholar
  15. 15.
    Devilléa WLJM, Bezemera PD, Bouter LM. Publications on diagnostic test evaluation in family medicine journals: an optimal search strategy. J Clin Epidemiol. 2000;53:65–9.CrossRefGoogle Scholar
  16. 16.
    Jones CM, Athanasiou T. Summary receiver operating characteristic curve analysis techniques in the evaluation of diagnostic tests. Ann Thorac Surg. 2005;79:16–20.CrossRefGoogle Scholar
  17. 17.
    Macaskill P, Gatsonis C, Deeks J, Harbord R, Takwoingi Y. Chapter 10: analysing and presenting results. In: Deeks J, Bossuyt P, Gatsonis C, eds. Cochrane handbook for systematic reviews of diagnostic test accuracy version 10: The Cochrane Collaboration; 2010.Google Scholar
  18. 18.
    Whiting P, Rutjes A, Westwood M, Mallett S, Deeks J, Reitsma J, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36.CrossRefGoogle Scholar
  19. 19.
    Zweig M, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem. 1993;39(4):561–77.Google Scholar
  20. 20.
    Abele JT, Swami VG, Russell G, Masson ECO, Flemming JP. The accuracy of single photon emission computed tomography/computed tomography arthrography in evaluating aseptic loosening of hip and knee prostheses. J Arthroplast. 2015;30:1647–51.CrossRefGoogle Scholar
  21. 21.
    Chew CG, Lewis P, Middleton F, Wijngaard R, Deshaies A. Radionuclide arthrogram with SPECT/CT for the evaluation of mechanical loosening of hip and knee prostheses. Ann Nucl Med. 2010;24:735–43.CrossRefGoogle Scholar
  22. 22.
    Claassen L, Ettinger M, Plaass C, Daniilidis K, Calliess T, Ezechieli M. Diagnostic value of bone scintigraphy for aseptic loosening after total knee arthroplasty. Technol Health Care. 2014;22:767–73.Google Scholar
  23. 23.
    Kitchener MI, Coats E, Keene G, Paterson R. Assessment of radionuclide arthrography in the evaluation of loosening of knee prostheses. Knee. 2006;13:220–5.CrossRefGoogle Scholar
  24. 24.
    Mandegaran R, Agrawal K, Vijayanathan S, Gnanasegaran G. The value of 99mTc-MDP bone SPECT/CT in evaluation of patients with painful knee prosthesis. Nucl Med Commun. 2018;39:397–404.CrossRefGoogle Scholar
  25. 25.
    Manthey N, Reinhard P, Moog F, Knesewitsch P, Hahn K, Tatsch K. The use of [18F] fluorodeoxyglucose positron emission tomography to differentiate between synovitis, loosening and infection of hip and knee prostheses. Nucl Med Commun. 2002;23:645–53.CrossRefGoogle Scholar
  26. 26.
    Mayer-Wagner S, Mayer W, Maegerlein S, Linke R, Jansson V, Müller PE. Use of 18F-FDG-PET in the diagnosis of endoprosthetic loosening of knee and hip implants. Arch Orthop Trauma Surg. 2010;130:1231–8.CrossRefGoogle Scholar
  27. 27.
    Sacchetti G, Ghisellini F, Brambilla M, Consoli AD, Fornara P, Rizzo E, et al. Quantitative Scintigraphic evaluation of total knee arthroplasties: a feasibility study. Clin Orthop Relat Res. 1996;325:181–9.CrossRefGoogle Scholar
  28. 28.
    Smith SL, Wastie ML, Forster I. Radionuclide bone scintigraphy in the detection of significant complications after total knee joint replacement. Clin Radiol. 2001;56:221–4.CrossRefGoogle Scholar
  29. 29.
    Sterner T, Pink R, Freudenberg L, Jentzen T, Quitmann H, Bockisch A, et al. The role of [18F] fluoride positron emission tomography in the early detection of aseptic loosening of total knee arthroplasty. Int J Surg. 2007;5:99–104.CrossRefGoogle Scholar
  30. 30.
    Verlooy H, Victor J, Renson L, Vandecruys A, Drent P, Mortelmans L, et al. Limitations of quantitative radionuclide bone scanning in the evaluation of total knee replacement. Clin Nucl Med. 1993;18(8):671–4.CrossRefGoogle Scholar
  31. 31.
    Marx A, Saxler G, Landgraeber S, Löer F, Holland-Letz T, Mv K. Comparison of subtraction arthrography, radionuclide arthrography and conventional plain radiography to assess loosening of total knee arthroplasty. Biomed Tech. 2005;50:143–7.CrossRefGoogle Scholar
  32. 32.
    Jaroma A, Suomalainen J-S, Niemitukia L, Soininvaara T, Salo J, Kröger H. Imaging of symptomatic total knee arthroplasty with cone beam computed tomography. Acta Radiol. 2018;59(12):1500–7.CrossRefGoogle Scholar
  33. 33.
    Verberne S, Sonnega R, Temmerman O, Raijmakers P. What is the accuracy of nuclear imaging in the assessment of periprosthetic knee infection? A meta-analysis. Clin Orthop Relat Res. 2017;475(5):1395–410.CrossRefGoogle Scholar

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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