Fulltext

The value of FDG-PET in patients with painful total knee arthroplasty

Stumpe, Katrin ; Romero, Jose ; Ziegler, Oliver ; Kamel, Ehab ; von Schulthess, Gustav ; Strobel, Klaus ; Hodler, Juerg

In: European Journal of Nuclear Medicine and Molecular Imaging, 2006, vol. 33, no. 10, p. 1218-1225

Add to personal list
    Title
    • The value of FDG-PET in patients with painful total knee arthroplasty
    Author
    • Stumpe, Katrin. Department of Medical Radiology, Division of Nuclear Medicine, University Hospital, Zurich, Switzerland
    • Romero, Jose. Orthopaedic Surgery, Orthopaedic University Hospital Balgrist, Zurich, Switzerland
    • Ziegler, Oliver. Orthopaedic Surgery, Orthopaedic University Hospital Balgrist, Zurich, Switzerland
    • Kamel, Ehab. Department of Medical Radiology, Division of Nuclear Medicine, University Hospital, Zurich, Switzerland
    • von Schulthess, Gustav. Department of Medical Radiology, Division of Nuclear Medicine, University Hospital, Zurich, Switzerland
    • Strobel, Klaus. Department of Medical Radiology, Division of Nuclear Medicine, University Hospital, Zurich, Switzerland
    • Hodler, Juerg. Department of Radiology, Orthopaedic University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • European Journal of Nuclear Medicine and Molecular Imaging, 2006, vol. 33, no. 10, p. 1218-1225. Springer-Verlag
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:316630
    Summary
    Purpose: The purpose of this study was to evaluate 18F-fluorodeoxyglucose (FDG) uptake in patients with painful total knee arthroplasty and to relate FDG uptake to the location of soft tissue pain. Methods: Twenty-eight patients with painful total knee arthroplasty had a clinical examination, standard radiographs, CT measurement of rotation of the femoral component and FDG-PET (18 PET/CT, 10 PET). The diagnosis of infection was based on microbiological examinations of surgical specimens (n=12) or clinical follow-up for at least 6 months (n=16), 99mTc-labelled monoclonal antibody scintigraphy and joint aspiration. Results: Twenty-seven of 28 patients presented with diffuse synovial FDG uptake. Additional focal extrasynovial FDG uptake was observed in 19 knees. Twenty-four of the 28 patients had a diagnosis of internal femoral malrotation. The remaining four patients showed no rotation (0°) and 3°, 4° and 7° of external rotation, respectively. Three patients presented with the additional diagnosis of an infected total knee replacement. Pain was described as diffuse (n=10) or focal (n=18). In two knees a relationship between pain location and FDG uptake was observed. Of ten patients with a severe internal femoral component rotation (>6°), seven had focal uptake, four in the femoral periosteum and three in the tibial periosteum. The difference between knees with severe malrotation and the remaining knees was not significant (p=1.000, Fisher's Exact Test). Conclusion: Diffuse synovial and focal extrasynovial FDG-PET uptake is commonly found in patients with malrotation of the femoral component and is not related to pain location. The information provided by FDG-PET does not contribute to the diagnosis and management of individual patients with persistent pain after total knee replacement