CORRInsights®: What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis

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When planning revision surgery, it is important to consider the possibility of infection. Surgeons can make a diagnosis based on a combination of clinical findings, elevated inflammatory markers, and joint aspiration. Joint aspiration is the most important diagnostic tool for identifying an infection since it can establish the diagnosis of PJI, detect the causative bacteria, and determine the antibiotic susceptibility [3, 5, 7].
Early and acute periprosthetic joint infections (PJIs) usually generate rather clear findings that rarely warrant further examination for infection. However, diagnosing late and low-grade infections can be challenging. Additional diagnostic methods like nuclear imaging may be helpful [2].
In their study, Verberne and colleagues examined the accuracy and efficacy of nuclear imaging for assessing PJI of the knee and found that, when including studies with wide confidence intervals and incomplete infectiological information, only 288 infected knees could be included in the meta-analysis. They confirmed that standard scintigraphy is insufficiently specific for diagnosing PJI. The authors also found that antigranulocyte scintigraphy, combined leukocyte and bone marrow scintigraphy, and FDG-PET are the most promising imaging methods because they offer more specificity. Though it should be noted that these methods can also be time-consuming, not broadly available, and rather expensive.

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