Skip to main content
SpringerLink
Log in

The value of FDG-PET in patients with painful total knee arthroplasty

  • Original article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate 18F-fluorodeoxyglucose (FDG) uptake in patients with painful total knee arthroplasty and to relate FDG uptake to the location of soft tissue pain.

Methods

Twenty-eight patients with painful total knee arthroplasty had a clinical examination, standard radiographs, CT measurement of rotation of the femoral component and FDG-PET (18 PET/CT, 10 PET). The diagnosis of infection was based on microbiological examinations of surgical specimens (n=12) or clinical follow-up for at least 6 months (n=16), 99mTc-labelled monoclonal antibody scintigraphy and joint aspiration.

Results

Twenty-seven of 28 patients presented with diffuse synovial FDG uptake. Additional focal extrasynovial FDG uptake was observed in 19 knees. Twenty-four of the 28 patients had a diagnosis of internal femoral malrotation. The remaining four patients showed no rotation (0°) and 3°, 4° and 7° of external rotation, respectively. Three patients presented with the additional diagnosis of an infected total knee replacement. Pain was described as diffuse (n=10) or focal (n=18). In two knees a relationship between pain location and FDG uptake was observed. Of ten patients with a severe internal femoral component rotation (>6°), seven had focal uptake, four in the femoral periosteum and three in the tibial periosteum. The difference between knees with severe malrotation and the remaining knees was not significant (p=1.000, Fisher's Exact Test).

Conclusion

Diffuse synovial and focal extrasynovial FDG-PET uptake is commonly found in patients with malrotation of the femoral component and is not related to pain location. The information provided by FDG-PET does not contribute to the diagnosis and management of individual patients with persistent pain after total knee replacement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Berger RA, Crossett LS, Jacobs JJ, Rubash HE. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 1998;356:144–153

    Article  PubMed  Google Scholar 

  2. Berger RA, Rubash HE. Rotational instability and malrotation after total knee arthroplasty. Orthop Clin North Am 2001;32:639–647, ix

    Article  PubMed  CAS  Google Scholar 

  3. Hofmann S, Romero J, Roth-Schiffl E, Albrecht T. Rotational malalignment of the components may cause chronic pain or early failure in total knee arthroplasty. Orthopade 2003;32:469–476

    PubMed  CAS  Google Scholar 

  4. Clarke HD, Scuderi GR. Flexion instability in primary total knee replacement. J Knee Surg 2003;16:123–128

    PubMed  Google Scholar 

  5. Argenson JN, Aubaniac JM. Total knee arthroplasty in femorotibial instability. Orthopade 2000;29 Suppl 1:S45–47

    Article  PubMed  Google Scholar 

  6. Nabeyama R, Matsuda S, Miura H, Kawano T, Nagamine R, Mawatari T, et al. Changes in anteroposterior stability following total knee arthroplasty. J Orthop Sci 2003;8:526–531

    Article  PubMed  Google Scholar 

  7. Malo M, Vince KG. The unstable patella after total knee arthroplasty: etiology, prevention, and management. J Am Acad Orthop Surg 2003;11:364–371

    PubMed  Google Scholar 

  8. Parker DA, Dunbar MJ, Rorabeck CH. Extensor mechanism failure associated with total knee arthroplasty: prevention and management. J Am Acad Orthop Surg 2003;11:238–247

    PubMed  Google Scholar 

  9. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 2002;404:7–13

    Article  PubMed  Google Scholar 

  10. Boldt JG, Munzinger UK, Zanetti M, Hodler J. Arthrofibrosis associated with total knee arthroplasty: gray-scale and power Doppler sonographic findings. AJR Am J Roentgenol 2004;182:337–340

    Google Scholar 

  11. Hendrix RW. Radiographic evaluation of prosthetic joints. Compr Ther 1988;14:36–48

    PubMed  CAS  Google Scholar 

  12. Ducheyne P, Kagan A, 2nd, Lacey JA. Failure of total knee arthroplasty due to loosening and deformation of the tibial component. J Bone Joint Surg Am 1978;60:384–391

    PubMed  CAS  Google Scholar 

  13. Hirsh DM, Bhalla S, Roffman M. Supracondylar fracture of the femur following total knee replacement. Report of four cases. J Bone Joint Surg Am 1981;63:162–163

    PubMed  CAS  Google Scholar 

  14. Bauer TW, Schils J. The pathology of total joint arthroplasty.II. Mechanisms of implant failure. Skeletal Radiol 1999;28:483–497

    Article  PubMed  CAS  Google Scholar 

  15. Van Acker F, Nuyts J, Maes A, Vanquickenborne B, Stuyck J, Bellemans J, et al. FDG-PET, 99mTc-HMPAO white blood cell SPET and bone scintigraphy in the evaluation of painful total knee arthroplasties. Eur J Nucl Med 2001;28:1496–1504

    Article  PubMed  CAS  Google Scholar 

  16. Briard JL, Hungerford DS. Patellofemoral instability in total knee arthroplasty. J Arthroplast 1989;4 Suppl:S87–97

    PubMed  Google Scholar 

  17. Merkow RL, Soudry M, Insall JN. Patellar dislocation following total knee replacement. J Bone Joint Surg Am 1985;67:1321–1327

    PubMed  CAS  Google Scholar 

  18. Romero J, Duronio JF, Sohrabi A, Alexander N, MacWilliams BA, Jones LC, et al. Varus and valgus flexion laxity of total knee alignment methods in loaded cadaveric knees. Clin Orthop Relat Res 2002;394:243–253

    Article  PubMed  Google Scholar 

  19. Sciuk J, Puskas C, Greitemann B, Schober O. White blood cell scintigraphy with monoclonal antibodies in the study of the infected endoprosthesis. Eur J Nucl Med 1992;19:497–502

    Article  PubMed  CAS  Google Scholar 

  20. Freeman MA, Sudlow RA, Casewell MW, Radcliff SS. The management of infected total knee replacements. J Bone Joint Surg Br 1985;67:764–768

    PubMed  CAS  Google Scholar 

  21. Goksan SB, Freeman MA. One-stage reimplantation for infected total knee arthroplasty. J Bone Joint Surg Br 1992;74:78–82

    PubMed  CAS  Google Scholar 

  22. Simmons TD, Stern SH. Diagnosis and management of the infected total knee arthroplasty. Am J Knee Surg 1996;9:99–106

    PubMed  CAS  Google Scholar 

  23. Schiesser M, Stumpe KD, Trentz O, Kossmann T, Von Schulthess GK. Detection of metallic implant-associated infections with FDG PET in patients with trauma: correlation with microbiologic results. Radiology 2003;226:391–398

    PubMed  Google Scholar 

  24. de Winter F, van de Wiele C, Vogelaers D, de Smet K, Verdonk R, Dierckx RA. Fluorine-18 fluorodeoxyglucose-position emission tomography: a highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections. J Bone Joint Surg Am 2001;83-A:651–660

    PubMed  Google Scholar 

  25. Stumpe KD, Notzli HP, Zanetti M, Kamel EM, Hany TF, Gorres GW, et al. FDG PET for differentiation of infection and aseptic loosening in total hip replacements: comparison with conventional radiography and three-phase bone scintigraphy. Radiology 2004;231:333–341

    PubMed  Google Scholar 

  26. Love C, Tomas MB, Marwin SE, Pugliese PV, Palestro CJ. Role of nuclear medicine in diagnosis of the infected joint replacement. Radiographics 2001;21:1229–1238

    PubMed  CAS  Google Scholar 

  27. Love C, Marwin SE, Tomas MB, Krauss ES, Tronco GG, Bhargava KK, et al. Diagnosing infection in the failed joint replacement: a comparison of coincidence detection 18F-FDG and 111In-labeled leucocyte/99mTc-sulfur colloid marrow imaging. J Nucl Med 2004;45:1864–1871

    PubMed  Google Scholar 

  28. von Schulthess GK, Meier N, Stumpe KD. Joint accumulations of FDG in whole body PET scans. Nuklearmedizin 2001;40:193–197

    PubMed  Google Scholar 

  29. Oi N, Iwaya T, Itoh M, Yamaguchi K, Tobimatsu Y, Fujimoto T. FDGPET imaging of lower extremity muscular activity during level walking. J Orthop Sci 2003;8:55–61

    Article  PubMed  Google Scholar 

  30. Meyer M, Gast T, Raja S, Hubner K. Increased F-18 FDG accumulation in an acute fracture. Clin Nucl Med 1994;19:13–14

    PubMed  CAS  Google Scholar 

  31. Zhuang H, Sam JW, Chacko TK, Duarte PS, Hickeson M, Feng Q, et al. Rapid normalization of osseous FDG uptake following traumatic or surgical fractures. Eur J Nucl Med Mol Imaging 2003;30:1096–1103

    Article  PubMed  Google Scholar 

  32. Kaim AH, Gross T, von Schulthess GK. Imaging of chronic posttraumatic osteomyelitis. Eur Radiol 2002;12:1193–1202

    Article  PubMed  Google Scholar 

  33. Akagi M, Yamashita E, Nakagawa T, Asano T, Nakamura T. Relationship between frontal knee alignment and reference axes in the distal femur. Clin Orthop Relat Res 2001;388:147–156

    Article  PubMed  Google Scholar 

  34. Schmidlin P. Improved iterative image reconstruction using variable projection binning and abbreviated convolution. Eur J Nucl Med 1994;21:930–936

    Article  PubMed  CAS  Google Scholar 

  35. Zhuang H, Duarte PS, Pourdehnad M, Maes A, Van Acker F, Shnier D, et al. The promising role of 18F-FDG PET in detecting infected lower limb prosthesis implants. J Nucl Med 2001;42:44–48

    PubMed  CAS  Google Scholar 

  36. Ryd L, Gustafson T, Lindstrand A. 99mTc-diphosphonate scintigraphy in successful knee arthroplasty and its relation to micromotion. Clin Orthop Relat Res 1993;287:61–67

    PubMed  Google Scholar 

  37. Rosenthall L, Lepanto L, Raymond F. Radiophosphate uptake in asymptomatic knee arthroplasty. J Nucl Med 1987;28:1546–1549

    PubMed  CAS  Google Scholar 

  38. Becker W, Pasurka B, Borner W. Significance of leukocyte scintigraphy of the infected total endoprosthesis. Rofo 1989;150:284–289

    PubMed  CAS  Google Scholar 

  39. Palestro CJ, Kim CK, Swyer AJ, Capozzi JD, Solomon RW, Goldsmith SJ. Total-hip arthroplasty: periprosthetic indium-111-labeled leukocyte activity and complementary technetium-99m-sulfur colloid imaging in suspected infection. J Nucl Med 1990;31:1950–1955

    PubMed  CAS  Google Scholar 

  40. Manthey N, Reinhard P, Moog F, Knesewitsch P, Hahn K, Tatsch K. The use of [18F]fluorodeoxyglucose positron emission tomography to differentiate between synovitis, loosening and infection of hip and knee prostheses. Nucl Med Commun 2002;23:645–653

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Radiology, Division of Nuclear Medicine, University Hospital, Zurich, Switzerland

    Katrin D. M. Stumpe, Ehab M. Kamel, Gustav K. von Schulthess & Klaus Strobel

  2. Department of Radiology, Orthopaedic University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland

    Juerg Hodler

  3. Orthopaedic Surgery, Orthopaedic University Hospital Balgrist, Zurich, Switzerland

    Jose Romero & Oliver Ziegler

  4. EndoClinic Zurich, Center for Joint Diseases at Hirslanden Clinic, Zurich, Switzerland

    Jose Romero

  5. Ortho Zentrum Rosenheim, Rosenheim, Germany

    Oliver Ziegler

  6. Division of Nuclear Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

    Ehab M. Kamel

Authors
  1. Katrin D. M. Stumpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jose Romero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Oliver Ziegler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ehab M. Kamel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gustav K. von Schulthess
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Klaus Strobel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Juerg Hodler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juerg Hodler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stumpe, K.D.M., Romero, J., Ziegler, O. et al. The value of FDG-PET in patients with painful total knee arthroplasty. Eur J Nucl Med Mol Imaging 33, 1218–1225 (2006). https://doi.org/10.1007/s00259-006-0127-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-006-0127-1

Keywords

Search

Navigation