ABSTRACT
INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Subject(s)
Arthroplasty, Replacement, Knee/adverse effects , Medical Overuse/prevention & control , Pain, Postoperative/diagnosis , Prosthesis Failure/adverse effects , Prosthesis-Related Infections , Radionuclide Imaging/methods , Aged , Arthroplasty, Replacement, Knee/methods , Clinical Decision-Making/methods , Female , Humans , Male , Middle Aged , Osteoarthritis, Knee/surgery , Outcome and Process Assessment, Health Care , Pain, Postoperative/etiology , Predictive Value of Tests , Prosthesis-Related Infections/complications , Prosthesis-Related Infections/diagnosis , Technetium/pharmacology , Unnecessary ProceduresABSTRACT
INTRODUCTION: The aim of this study was to assess the benefit of a Technetium-99M (HDP) 3-phase bone scan (TPBS) as an additional diagnostic test in the evaluation of pain in the hip region following cemented total hip replacement (THR) surgery. METHODS: A retrospective study over a 24-month period was performed comprising 100 patients investigated with a TPBS. Investigations were summarised and analysed, and were classified as entirely normal, possibly abnormal, and definitely abnormal. RESULTS: 45% (45) of TPBSs were reported as being entirely normal, 50% (50) as possibly abnormal, and 5% (5) as definitely abnormal. During the 24-month study period 230 revision THR procedures were performed at our institution; 10% (24) were investigated with TPBS and 90% (206) were not. 29% (7/24) of patients investigated with a TPBS that subsequently underwent revision THR surgery had an entirely normal preoperative TPBS. 84% (38) with an abnormal TPBS were managed conservatively. A TPBS had a sensitivity of 29% (95% confidence interval (CI), 13%-51%) and a specificity of 50% (95% CI, 38%-62%) in the detection of infection, or loosening with concurrent infection. CONCLUSION: 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.
Subject(s)
Arthralgia/diagnostic imaging , Arthroplasty, Replacement, Hip/adverse effects , Pain, Postoperative/diagnostic imaging , Radionuclide Imaging , Technetium , Aged , Aged, 80 and over , Arthralgia/etiology , Bone Cements , Female , Hip Prosthesis , Humans , Male , Middle Aged , Pain, Postoperative/etiology , Reoperation , Retrospective Studies , Sensitivity and SpecificityABSTRACT
We report the case of a 74-year-old male with an incidental finding of a pseudoaneurysm at the base of his neck arising from the left subclavian artery. Initial treatment with ultrasound-guided thrombin injection was unfortunately unsuccessful with early recanalization. An Amplatzer Vascular Plug 4 device was introduced into the neck of the pseudoaneurysm endovascularly with successful thrombosis and occlusion of the pseudoaneurysm.
Subject(s)
Aneurysm, False/therapy , Embolization, Therapeutic/instrumentation , Endovascular Procedures/instrumentation , Subclavian Artery , Aged , Aneurysm, False/diagnostic imaging , Angiography, Digital Subtraction , Computed Tomography Angiography , Equipment Design , Humans , Incidental Findings , Male , Subclavian Artery/diagnostic imaging , Treatment OutcomeABSTRACT
We report the case of a large superior gluteal artery aneurysm treated with covered stent-graft insertion. Exclusion of the aneurysm was achieved, with resolution of symptoms and shrinkage of the sac, without the need for embolization.
