Utility of radiolabeled leukocyte and bone marrow scintigraphy with SPECT/CT in the diagnostic work-up- of the painful prosthetic joint: A single-institution experience

ABSTRACT

@#In tbhe assessment of prosthetic joint pains, differentiating between aseptic loosening and infection can be challenging due to their similarities in clinical presentation and histopathology. Combined radiolabeled leukocyte and bone marrow scintigraphy and SPECT/CT is considered the most suitable nuclear imaging modality for this purpose. However, this is infrequently performed in our local setting. We present two cases where these studies were appropriately performed with different scan outcomes. The first case involved a 67-year-old male with painful right knee prosthesis and an alleged history of recurrent periprosthetic joint infection (PJI). The leukocyte tagging scan and marrow scan images were found to be congruent, which was more compatible with aseptic loosening. No emergent surgical intervention was done in our hospital, and the patient returned to this home territory for further management. The second case was a 72-year-old male with progressive pain in his left prosthetic hiip which began after surgery a year prior. Scan images were incongruent, suggestive of PJI; this was confired on joint aspiration and eventual surgical revision. Despite this imaging study's high sensitvity and high specificity, it has not been well-received in management algorihms of PJI. Collaboration between clinicans and nuclear imaging specilists is key in increasing the general use of these procedures.