WHITE CELL SCANS AND INFECTED JOINT REPLACEMENTS

We report the results of imaging with labelled white cells in 52 patients before the revision of 54 cemented joint prostheses at which the diagnosis of infection was made from biopsies. Twenty-five hips were imaged with Inoxine-labelled cells; 20 hips and 11 knees were imaged with Of these, 13 hips and five knees proved to be infected. The scans taken together had an accuracy of 82%, a sensitivity of 44% and a specificity of 100%. Indium scans gave 37% sensitivity, 99mTc labelling 50% sensitivity. Infected arthroplasties with positive scans had presented significantly earlier than those with negative scans, the time after the original insertion being 1.1 years for the truepositive scans and 6.1 years for the false-negative scans. The value of labelled white-cell scans in the detection of infection in failedjoint replacements is dependent on the activity of the infection. There is reduced sensitivity to the more insidious infections which affect arthroplasties and aspirationundercontrolledconditions remainsan important investigation.

[1]  A. Bockisch,et al.  Diagnosis of bone and joint infection by leucocyte scintigraphy , 1990, Archives of Orthopaedic and Trauma Surgery.

[2]  P. Roberts,et al.  Diagnosing infection in hip replacements. The use of fine-needle aspiration and radiometric culture. , 1992, The Journal of bone and joint surgery. British volume.

[3]  J. Setoain,et al.  99Tcm-HMPAO leucocyte scintigraphy in the diagnosis of bone infection , 1991, Nuclear medicine communications.

[4]  S. Goldsmith,et al.  Total-hip arthroplasty: periprosthetic indium-111-labeled leukocyte activity and complementary technetium-99m-sulfur colloid imaging in suspected infection. , 1990, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[5]  J. Rand,et al.  The value of indium 111 leukocyte scanning in the evaluation of painful or infected total knee arthroplasties. , 1990, Clinical orthopaedics and related research.

[6]  A. U. Daniels,et al.  Bone Scans After Total Knee Arthroplasty in Asymptomatic Patients Cemented Versus Cementless , 1990, Clinical orthopaedics and related research.

[7]  T. Lantto,et al.  Technetium-99m HM-PAO-labeled leukocytes in detection of inflammatory lesions: comparison with gallium-67 citrate. , 1989, Journal of Nuclear Medicine.

[8]  M. Patel,et al.  A simple method of identifying loosening or infection of hip prostheses in nuclear medicine , 1989, Nuclear medicine communications.

[9]  Å. Carlsson,et al.  The diagnostic value of C-reactive protein in infected total hip arthroplasties. , 1989, The Journal of bone and joint surgery. British volume.

[10]  M. Janabi,et al.  A rapid method for the preparation of 99Tcm hexametazime-labelled leucocytes. , 1988, Nuclear medicine communications.

[11]  M. Brown,et al.  In-111-labeled leukocyte scintigraphy in suspected orthopedic prosthesis infection: comparison with other imaging modalities. , 1988, Radiology.

[12]  J. Wu,et al.  Erythrocyte sedimentation rate and C-reactive protein values in patients with total hip arthroplasty. , 1987, Clinical orthopaedics and related research.

[13]  J. Callaghan,et al.  Diagnosis of infection by preoperative scintigraphy with indium-labeled white blood cells. , 1987, Journal of Bone and Joint Surgery. American volume.

[14]  V. Valtonen,et al.  Sensitivity of 111In-Granulocyte Scintigraphy in Various Local Infections , 1987, Acta radiologica.

[15]  R. Lull,et al.  Asymptomatic total hip prosthesis: natural history determined using Tc-99m MDP bone scans. , 1986, Radiology.

[16]  S. Osman,et al.  CLINICAL EXPERIENCE WITH 99mTc-HEXAMETHYLPROPYLENE-AMINEOXIME FOR LABELLING LEUCOCYTES AND IMAGING INFLAMMATION , 1986, The Lancet.

[17]  T. Krausz,et al.  Autologous granulocyte scanning of painful prosthetic joints. , 1986, The Journal of bone and joint surgery. British volume.

[18]  M. Brown,et al.  Comparison of indium-labeled-leukocyte imaging with sequential technetium-gallium scanning in the diagnosis of low-grade musculoskeletal sepsis. A prospective study. , 1985, The Journal of bone and joint surgery. American volume.

[19]  J. Costerton,et al.  Bacterial adherence to biomaterials and tissue. The significance of its role in clinical sepsis. , 1985, The Journal of bone and joint surgery. American volume.

[20]  W. Harris,et al.  Failed total hip replacement: assessment by plain radiographs, arthrograms, and aspiration of the hip joint. , 1984, The Journal of bone and joint surgery. American volume.

[21]  R D Sturrock,et al.  Scintigraphic evaluation of the painful prosthetic joint: a comparison of gallium-67 citrate and indium-111 labelled leucocyte imaging. , 1984, Clinical radiology.

[22]  B. Weissman.  The radiology of total joint replacement. , 1983, The Orthopedic clinics of North America.

[23]  G. Sfakianakis,et al.  Comparisons of scintigraphy with In-111 leukocytes and Ga-67 in the diagnosis of occult sepsis. , 1982, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[24]  N. Rushton,et al.  The value of technetium and gallium scanning in assessing pain after total hip replacement. , 1982, The Journal of bone and joint surgery. British volume.

[25]  J. Tinkler,et al.  The isolation of bacteria of low pathogenicity from faulty orthopaedic implants. , 1981, The Journal of hospital infection.

[26]  C. Kamme,et al.  Aerobic and anaerobic bacteria in deep infections after total hip arthroplasty: differential diagnosis between infectious and non-infectious loosening. , 1981, Clinical orthopaedics and related research.

[27]  G. Hunter,et al.  The results of revision of total hip arthroplasty. , 1979, The Journal of bone and joint surgery. British volume.

[28]  P. D. Wilson,et al.  Treatment of subacute sepsis of the hip by antibiotics and joint replacement. Criteria for diagnosis with evaluation of twenty-six cases. , 1979, Clinical orthopaedics and related research.

[29]  Å. Carlsson.  Erythrocyte sedimentation rate in infected and non-infected total-hip arthroplasties. , 1978, Acta orthopaedica Scandinavica.

[30]  M. Thakur,et al.  Indium-111-labeled autologous leukocytes in man. , 1977, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.