The Role of Combination of Three-Phase Bone, Labeled Leukocyte and Bone Marrow Scintigraphy in the Diagnosis of Periprosthetic Infections

Aim: Many methods are available in the differential diagnosis of infection and relaxation in hip and knee prosthesis. Moreover, many radiopharmaceuticals have been examined in nuclear medicine. The present study investigated the efficacy of the combination of three-phase bone, labeled leukocyte and bone marrow scintigraphy for detecting infections in hip and knee prostheses. Matarials abd Methods: This study included 89 patients with pre-diagnosed prosthetic infections. The patients were divided into two groups, namely, hip arthroplasty group (group I: 40 women and 16 men) and knee arthroplasty group (group II: 25 women and 8 men). All the patients underwent Tc-99m MDP three-phase bone scintigraphy, Tc-99m HMPAO-labelled leukocyte scintigraphy and Tc-99m sulphide colloid bone marrow scintigraphy at a minimum of 2-day intervals and were followed up for 6 months to 2.5 years. In all, 33 (39%) patients underwent an operation after the scintigraphies. Sensitivity, specificity and accuracy of the methods were calculated by considering the results of the surgery and findings of the clinical follow-up as the gold standard. Agreement among the methods was analysed using Kappa values, and p < 0.001 was considered to be statistically significant. Results: Sensitivity, specificity and accuracy of the combined diagnostic approach were 85%, 97% and 94%, respectively, in the hip arthroplasty group and 75%, 100% and 96%, respectively, in the knee arthroplasty group. Conclusion: These results indicate that the combination of the three-phase bone, labelled leukocyte and bone marrow scintigraphy was the best choice based on the results of all cases suspected of all prosthetic infections.