The clinical use of three-phase bone scintigraphy in identifying complications after hip replacement in liquidators of accident at the Chernobyl Nuclear Power Plant with septic and aseptic osteoarthrosis

Introduction: To evaluate the prognostic role of kinetic parameters of three-phase bone scintigraphy in identifying complications after hip replacement of liquidators of accident at the Chernobyl Nuclear Power Plant (ChNPP) with septic and aseptic osteoarthrosis (OA).

Methods: 241 patients (185 men and 56 women) aged 31 to 85 years were imaged by three-phase bone scintigraphy: I stage - angiographic phase, II stage - early static phase, III stage - delayed static phase. Intestinal uptake was observed visually 3 hours after the intravenous administration of 740 MBq ^99mTc MDP.

Results: According to the results of microbiological analysis of diagnostic puncture of the hip joints, the patients were divided into two cohorts. The first cohort included 152 patients with aseptic OA of the hip joint, the second - 89 patients with septic OA. Significant increase of the parameters of arterial inflow (t = 2.27; p <0.05) and integral perfusion (t = 2.52; p <0.05) in the angiographic phase of patients with septic OA, due to the intensification of osteoblastic activity and angiogenesis, in comparison with indicators of aseptic OA. The kinetic of ^99mTc MDP in lesions of septic OA is characterized by significant predominance of retention (t = 3.04; p <0.05) and specific accumulation of the drug in the early static phase (t = 2.17; p <0.05) and delayed static phase of scintigraphy ( t = 2.11; p <0.05), compared with indicators for aseptic OA. According to the results of kinetic analysis, aseptic OA results in rapid elimination of ^99mTc MDP from the lesion, due to the active leaching of the radiopharmaceutical, due to the decrease in blood supply to the tissues of the area - a retentive "failure". In septic OA there was a gradual increase in the percentage of accumulation of the radiological indicator in the lesion, which is due to the intensification of integral perfusion, increased permeability of blood vessels due to the action of infectious agents, activation of resorption factors and synthesis of mineral components.

Conclusions: The use of three-phase bone scintigraphy contributes to the early detection of paraendoprosthetic complications in the postoperative period, the reduction of the number of revision endoprosthetics and the shortening of the rehabilitation measures after the hip replacement in the liquidators of accident ChNPP.