Three-phase Technetium-99m bone scanning in patients with pain in the knee region after cemented total knee arthroplasty

  • Daniel S. HillEmail author
  • Denis Kinsella
  • Andrew D. Toms
Original Article • KNEE - ARTHROPLASTY



Our aim was to question the usefulness of a three-phase bone scan in the evaluation of pain in the knee region after TKR. Our hypothesis was that an abnormal investigation had a poor association with the presence of infection or loosening, and did not provide any additional diagnostic information above that already available through other standard investigations.


A retrospective study over a 24-month period was performed comprising 118 patients investigated with a TPBS. Investigations were summarised and analysed, and were classified as entirely normal, possibly abnormal, and definitely abnormal.


Thirty-three per cent (39/118) of TPBSs were reported as being entirely normal, 59% (69/118) as possibly abnormal, and 8% (10/118) as definitely abnormal. During the 24-month study period, 131 revision TKR procedures were performed at our institution; 9% (12/131) were investigated with TPBS and 91% (119/131) were not. No patient with an entirely normal pre-operative TPBS underwent revision TKR surgery. Eighty-five per cent (67/79) with an abnormal TPBS were managed conservatively. In our series, a TPBS had a positive predictive value of 2.53%, a negative predictive value of 100%, with an overall accuracy of 34.75% with 100% sensitivity (97.5% one-sided confidence interval 0–24.71%), and 33.62% specificity (95% confidence interval 53.29–72.37%), in the diagnosis of infection, or loosening with concurrent infection in determining the indication for revision surgery.


A TPBS should only be considered following clinical evaluation, serological investigation, diagnostic imaging, and microbiological analysis of fluid obtained from arthrocentesis by a specialist revision arthroplasty surgeon. A TPBS may be useful in the situation where abnormal serology is present, but where repeated joint aspirations samples are inconclusive.


Pain in the knee region Cemented total knee replacement Three-phase Technetium-99m bone scan Revision arthroplasty 



We would like to acknowledge the support of our Statistical Advisor Dr. Roy J. Powell, B.Sc. (Hons), Ph.D., CBIOL, FSB, FHEA. Research Design Consultant, Research Design Service (RDS) South West.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The National Research Ethics Committee reviewed the protocol for this work and stated that formal ethical approval was not required.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Daniel S. Hill
    • 1
    Email author
  • Denis Kinsella
    • 1
  • Andrew D. Toms
    • 1
  1. 1.Princess Elizabeth Orthopaedic CentreRoyal Devon and Exeter Foundation TrustExeterUK

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