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Three-Phase Bone Scan and Indium White Blood Cell Scintigraphy Following Porous Coated Hip Arthroplasty: A Prospective Study of the Prosthetic Tip

Nuclear Medicine Service and Orthopedic Service, Walter Reed Army Medical Center, Washington, DC
The Uniformed Services University of Health Sciences, Bethesda, Maryland

Correspondence: For reprints contact: Douglas Van Nostrand, MD, Nuclear Medicine Dept., Good Samaritan Hosp., 5601 Loch Raven Blvd., Baltimore, MD 21239.

ABSTRACT

Although few reports address the use of three-phase bone scanning (TPBS)and ¹¹¹In-labeled white blood cell (In-WBC) scintigraphy in hip arthroplasty utilizing a porous coated prosthesis, the literature suggests that scintigraphic patterns in the uncomplicated patient may differ from that seen in the cemented prosthesis. In an attempt to determine the scintigraphic natural history, 25 uncomplicated porous coated hip arthroplasties in 21 patients were prospectively studied with serial TPBS and In-WBC at 7 days, and at 3, 6, 12, 18, and 24 mo postoperatively. This report deals with findings related to the prosthetic tip. Only one of 136 flow studies were abnormal and only two of 136 blood-pool images demonstrated focally increased activity. All 25 prostheses (120 of 143 scans) demonstrated increased uptake on the bone phase images. The area about the tip was divided into three segments; increased uptake at 24 mo was noted in the medial, distal, and lateral segments in 16%, 72%, and 56% of prostheses, respectively. Twenty of 25 prostheses (82 of 142 scans) showed uptake on In-WBC scintigraphy, being noted in 48% of prostheses at 24 mo. We conclude that scintigraphic patterns in the uncomplicated patient with a porous coated prosthesis appear to differ from patterns described in cemented prostheses.

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