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The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

¹ Department of Nuclear Medicine of the Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; ² Department of Orthopedic Surgery of the Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; ³ Department of Radiology, Stanford University Hospital, Stanford, California; and ⁴ Department of General Surgery of the Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Correspondence: For correspondence or reprints contact: Mordechai Lorberboym, Department of Nuclear Medicine, Edith Wolfson Medical Center, Holon, 58100, Israel. E-mail: mvlorber{at}zahav.net.il

The aim of this study was to assess the pattern of annexin V uptake in hip and knee prostheses suspected of being infected. Methods: A total of 7 patients undergoing revision surgery for hip or knee prostheses were studied; 5 patients had total hip replacements, and 2 had total knee replacements. Infection was confirmed by pathology, culture results, laboratory evaluation, and clinical follow-up. All patients also underwent a bone scan before surgery. Results: Annexin V scan findings were positive in 5 patients and negative in 2. Annexin V uptake was either focal (n = 4) or linear (n = 1). There were 4 true-positive, 2 true-negative, 1 false-positive, and no false-negative annexin V studies. Annexin V uptake was either more extensive or less extensive than, and usually was incongruent with, ^99mTc-methylene diphosphonate uptake. Conclusion: Our findings suggest that annexin V imaging shows greater uptake with infection than with aseptic loosening and has a high negative predictive value for prosthetic infection.

Key Words: apoptosis • annexin V • hip • knee • prosthesis • loosening • infection

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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