ABSTRACT
We investigated the usefulness of 99Tc(m)-polyclonal human IgG (99Tc[m]-HIG) scintigraphy in the diagnosis of infected hip and knee prostheses. Twenty-nine scintigraphic studies were performed in 27 patients (17 females, 10 males) with a suspected prosthetic infection. As some patients had bilateral prostheses, a total of 35 prostheses were evaluated. There were 25 hip replacements and 10 knee prostheses. The images were analysed both visually and quantitatively. The scintigraphic results were compared with the culture results of surgical specimens and also with clinical follow-up after 3 months. Increased uptake was observed in 22 prostheses, of which 12 were true-positive and 10 were false-positive results. Staphylococci were the agents most commonly isolated. In all false-positive patients, aseptic inflammation was diagnosed. Based on quantitative analysis, no statistically significant difference was found between the true-positive and false-positive cases. For the prostheses as a whole, the sensitivity, specificity, positive predictive value and negative predictive value were 100%, 41%, 54% and 100% respectively. For the hip prostheses alone, these values were 100%, 53%, 57% and 100% respectively. Taking its high sensitivity and predictive value into consideration, 99Tc(m)-HIG scintigraphy can be used as a screening test to help eliminate prosthetic infection.
Subject(s)
Hip Prosthesis/adverse effects , Immunoglobulin G , Knee Prosthesis/adverse effects , Organotechnetium Compounds , Prosthesis Failure , Prosthesis-Related Infections/diagnostic imaging , Radiopharmaceuticals , Adult , Aged , Diagnosis, Differential , False Positive Reactions , Female , Follow-Up Studies , Humans , Inflammation , Male , Middle Aged , Predictive Value of Tests , Radionuclide Imaging , Reoperation , Sensitivity and Specificity , Time FactorsABSTRACT
Twenty-four patients (29 hips) undergoing total hip arthroplasty were routinely given 75 mg of indomethacin daily for 4 weeks after operation and reviewed radiographically for heterotopic ossification (HO) for a minimum of 6 months. A comparison group of 25 patients (27 hips) without indomethacin treatment was formed and studied in the same manner. This group of patients received the usual postoperative analgesic treatment, which is diclofenac sodium twice daily parenterally for 5-10 days. The indomethacin group also received the same treatment. In the indomethacin group no patient had grade II, III, and grade IV HO and the incidence of grade I HO was 31% (nine patients). In the comparison group one patient (3%) had grade I, three (11%) grade II, and eight (30%) grade III HO. These findings suggested that indomethacin effectively prevented higher grades of HO following total hip arthroplasty. Two patients not included in the study had gastrointestinal bleeding and recovered after withdrawal of the drug.
Subject(s)
Hip Prosthesis , Indomethacin/therapeutic use , Ossification, Heterotopic/prevention & control , Postoperative Complications/prevention & control , Adult , Aged , Female , Humans , Male , Middle Aged , Ossification, Heterotopic/etiology , Prospective StudiesABSTRACT
Complete subtalar release was performed in 18 children with 22 clubfeet between 1987 and 1989. The ages of the patients ranged from 3.5 months to 8.5 years. The patients were evaluated at 9 to 30 months (average 19 months). Twenty procedures were performed through the Cincinnati incision, and the remaining two through two separate posteromedial and posterolateral incisions. At 6 weeks, the pins were removed and cast immobilization was discontinued at 3 to 3.5 months. Complications were superficial necrosis in three feet, and extensive posteromedial skin necrosis in one foot. No recurrences were encountered. Overall results were very good in 18, and good in four feet.
Subject(s)
Clubfoot/surgery , Subtalar Joint/surgery , Child , Child, Preschool , Clubfoot/diagnostic imaging , Clubfoot/etiology , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , Infant , Male , Methods , Radiography , Recurrence , Rotation/adverse effectsABSTRACT
In view of the rarity of isolated bone tuberculosis a case is reported here. Clinical and laboratory findings are also described. The patient was a nine-year-old boy. We were unable to find any other case of isolated tuberculosis reported in the literature.
