Research Papers:

Diagnosis of peri-prosthetic loosening of total hip and knee arthroplasty using 18F-Fluoride PET/CT

Sebastian Koob _, Florian C. Gaertner, Tom Rainer Jansen, Jan Schmolders, Sascha Gravius, Holger Strunk, Dieter Christian Wirtz and Markus Essler

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Oncotarget. 2019; 10:2203-2211. https://doi.org/10.18632/oncotarget.26762

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Sebastian Koob1, Florian C. Gaertner2, Tom Rainer Jansen1, Jan Schmolders1, Sascha Gravius1, Holger Strunk3, Dieter Christian Wirtz1 and Markus Essler2

1Clinic for Orthopedics and Trauma Surgery, University of Bonn, Bonn, Germany

2Clinic for Nuclear Medicine, University of Bonn, Bonn, Germany

3Department of Radiology, University of Bonn, Bonn, Germany

Correspondence to:

Sebastian Koob, email: [email protected]

Keywords: periprosthetic loosening; bone imaging; total hip arthroplasty; periprosthetic infection; 18F-Flouride PET/CT

Received: October 11, 2018    Accepted: February 01, 2019    Published: March 15, 2019


Periprosthetic loosening, either aseptic or induced by periprosthetic joint infection remains a major long term complication and challenge in orthopedics and trauma surgery. Sensitivity of potential loosening of the material and other causes of a painful prosthesis is essential for choosing the respective treatment option and providing the needed resources. 18F-Fluoride is a radiopharmaceutical which shows a high affinity to bone and a rapid blood clearance.

The objective of this study was to assess 18F-Fluoride PET/CT´s sensitivity and specificity in diagnosing periprosthetic loosening in total hip and knee arthroplasty.

We included 26 patients with 24 hip and 13 knee prostheses in our retrospective study with radiological or clinical suspicion of peri-prosthetic loosening at least one year after implantation. Results of 18F-Fluoride PET/CT imaging were compared with surgical results or clinical follow-up if surgery was not performed. On the basis of our data we found a sensitivity of 95.00 %, a specificity of 87.04 % and an accuracy of 89.19 % for 18F-Fluoride PET/CT.

The results of our study show that 18F-Fluoride PET/CT is a useful and promising technique in diagnosing periprosthetic loosening of total hip and knee arthroplasties. Further investigation should focus on different uptake patterns of the isotope in periprosthetic joint infection and therefore distinguishing aseptic from septic loosening and enhancing the diagnostic value of this imaging method.

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