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Three-phase bone scan pattern in asymptomatic uncemented total knee arthroplasty

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In this study we investigated the bone scan pattern in a homogeneous group of asymptomatic patients implanted with the same type of total knee arthroplasty (TKA) and with a minimum follow-up of 2 years. Twenty-nine patients (21 females, 8 males, mean age 62 years), with a total of 30 uncemented Hofmann TKAs, were entered in the study. The time interval from surgery to scintigraphic evaluation ranged from 2 to 4 years. Bone scan was performed using the three-phase technique and images were interpreted by visual analysis using a three-point scale for the dynamic and blood pool phases and a five-point scale for the bone phase. Areas of increased periprosthetic technetium-99m methylene diphosphonate (MDP) uptake were observed until 4 years after surgery. However, comparing the TKAs implanted 2, 3 and 4 years previously, a decreasing pattern in tracer uptake intensity was noted this being more evident in the femoral and lateral tibial components. In some cases, a persistently elevated tracer uptake, not exceeding a moderate grade, was found in the medial tibial component. In conclusion, increased periprosthetic99mTc-MDP uptake is a common finding in asymptomatic uncemented Hofmann TKAs for a prolonged period after surgery, but the uptake intensity is generally mild or moderate and shows a characteristic decreasing pattern over time. Furthermore, in contrast with other types of asymptomatic knee implants previously investigated, no case of high or very high bone uptake was recorded with this type of implant. We may speculate that scintigraphic parameters of normality, and pathology, should be determined for each type of TKA. It is likely that, with the uncemented Hofmann TKA, a high or very high tracer uptake or a progressive increase in the uptake intensity is suggestive of the presence of complications.

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  1. Rosenthall L, Lepanto L, Raymond F. Radiophosphate uptake in asymptomatic knee arthroplasty.J Nucl Med 1987; 28: 1546–1549.

    PubMed  Google Scholar 

  2. Ryd L, Gustafson T, Lindstrand A.99mTc-diphosphonate scintigraphy in successful knee arthroplasty and its relation to micromotion.Clin Orthop 1990; 287: 61–67.

    Google Scholar 

  3. Lull RJ, Utz JA, Jackson JH, etal. Radionuclide evaluation of joint disease. In: Freeman LM, Weissman HS, eds.Nuclear medicine annuals. New York: Raven Press; 1983: 281–328.

    Google Scholar 

  4. Oswald SG, Van Nostrand D, Savory CG, Callaghan JJ. Three-phase bone scan and indium white blood cell scintigraphy following porous-coated hip arthroplasty: a prospective study of the prosthetic tip.J Nucl Med 1989; 30: 1321–1331.

    PubMed  Google Scholar 

  5. Oswald SG, Van Nostrand D, Savory CG, Anderson JH, Callaghan JJ. The acetabulum: a prospective study of three-phase bone and indium white blood cell scintigraphy following porous-coated hip arthroplasty.J Nucl Med 1990; 31: 274–280.

    PubMed  Google Scholar 

  6. Ashbrooke AB, Calvert PT. Bone scan appearances after uncemented hip replacement.J R Soc Med 1990; 83: 768–769.

    PubMed  Google Scholar 

  7. Rosenthall L, Ghazal ME, Brooks CE. Quantitative analysis of radiophosphate uptakes in asymptomatic porous-coated hip endoprostheses.J Nucl Med 1991; 32: 1391–1393.

    PubMed  Google Scholar 

  8. Rubello D, Borsato N, Zanco P, Chierichetti F, Ferlin G. Three-phase bone scintigraphy pattern of loosening in uncemented hip prostheses.Eur J Nucl Med 1995; 22: 299–301.

    PubMed  Google Scholar 

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Rubello, D., Caricasulo, D., Borsato, N. et al. Three-phase bone scan pattern in asymptomatic uncemented total knee arthroplasty. Eur J Nucl Med 23, 1400–1403 (1996).

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