Normal range of osteoblastic activity in total hip arthroplasties on single-photon emission computed tomography bone scintigraphy

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Knowledge of the normal range of periprosthetic osteoblastic activity around total hip arthroplasties is required for rational diagnosis of complications. The aim of this study was to establish such a normal range for single-photon emission computed tomography (SPECT). Clinical utility of such a range is confident differentiation of normal from abnormal arthroplasties.


A total of 122 asymptomatic acetabular cups (age: 0–22 years) and 71 femoral stems (age: 0–20 years) were scanned with SPECT/CT. Two acetabular and three femoral activity ratios to normal reference bone were defined [acetabular axial (AA/RA), acetabular coronal (AC/RA), RA=reference acetabulum; femoral calcar (FC/RF), femoral mid-stem (FM/RF), femoral stem tip (FS/RF), RF=reference femur]. Upper cut-off of normal was defined as mean +3 SD (rounded). Two time breakpoints were analysed (12 and 24 months).


The upper cut-off for the normal range was 1.0 for AA/RA, 1.5 for AC/RA and 2.2 for all thee of FC/RF, FM/RF and FS/RF. AA/RA, FM/RF and FS/RF showed no statistically significant temporal trends. AC/RA showed stabilization of activity after 12 months and FC/RF after 24 months.


Measured activity ratios that fall within our normal range are likely to represent normal periprosthetic osteoblastic activity. Measured activity ratios that fall above the upper cut-offs of our normal range are likely to be abnormal. The cut-offs are robust in clinical practice and have utility in discriminating normal from abnormal stabilized arthroplasties where visual interpretation is ambiguous. Elevated AC/RA under 12 months and FC/RF under 24 months may represent normal periprosthetic activity and should be interpreted with caution.

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