Skip to main content
SpringerLink
Log in

Diagnose septischer Hüftprothesenlockerung via LeukoScan

SPECT-Scan mit 99mTc-markierten monoklonalen Antikörpern

Diagnosis of septic loosening of hip prosthesis with LeukoScan

SPECT scan with 99mTc-labeled monoclonal antibodies

  • Originalien
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Die Antigranulozytenszintigraphie (AGS) zum Nachweis septischer Hüftprothesenlockerungen wurde analysiert. 21 Hüftprothesen wurden mittels Laborparametern und anschließender, bei erhöhten Werten, 3-Phasen-Skelettszintigraphie und AGS untersucht. Wahlweise wurden SPECT/CT-Scans durchgeführt. Zur Diagnosesicherung dienten histologische und mikrobiologische Untersuchungen.

Die AGS-Analyse ergab eine Sensitivität, Spezifität und Effizienz von 1 und einen positiven und negativen prädiktiven Wert von jeweils 1. Die 3-Phasen-Skelettszintigraphie zeigte eine Sensitivität von 1 und eine Spezifität von 0,33 auf. In 3 Fällen bekräftigten SPECT/CT-Scans die AGS-Interpretation. Diese Stufendiagnostik erweist sich als aussagekräftig zur Detektion septischer Lockerungen. Somit lassen sich AGS vermeiden ohne das Infektionen übersehen werden.

Abstract

Diagnosis of septic loosening of hip endoprosthesis with antigranulocyte scintigraphy (AGS) was analysed. Twenty-one hip prostheses were studied using laboratory tests and, in cases of elevated values, three-phase bone scan (BS) and AGS. Elective SPECT/CT scans were performed. Histologic and microbiologic exams verified the diagnosis.

The AGS analysis revealed sensitivity, specificity and accuracy of value 1, while positive and negative predictive values were also 1. BS showed sensitivity of 1 and specificity of 0.33. In three cases, SPECT/CT scans corroborated the AGS interpretation. This diagnostic algorithm proved effective in the detection of septic loosening of hip prostheses. AGS can be avoided without risk of infection being overlooked.

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

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Atkins BL, Athanasou N, Deeks JJ et al. (1998) Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group. J Clin Microbiol 36: 2932–2939

    CAS  PubMed  Google Scholar 

  2. Becker W (1995) The contribution of nuclear medicine to the patient with infection. Eur J Nucl Med 22: 1195–1211

    Google Scholar 

  3. Becker W, Bair J, Behr T et al. (1994) Detection of soft-tissue infections and osteomyelitis using a technetium-99m-labeled anti-granulocyte monoclonal antibody fragment. J Nucl Med 35 (9): 1436–1443

    CAS  PubMed  Google Scholar 

  4. Becker W, Palestro CJ, Winship J, Feld T, Pinsky CM, Wolf F, Goldenberg DM (1996) Rapid imaging of infectious with a monoclonal antibody fragment (LeukoScan®). Clin Orthop 329: 263–272

    Google Scholar 

  5. Berbari EF, Hanssen AD, Duffy MC et al. (1998) Risk factors for prosthetic joint infection: case control study. Clin Infect Dis 27: 1247–1254

    CAS  PubMed  Google Scholar 

  6. Buscombe JR, Lui D, Ensing G, de Jong R, Ell PJ (1990)99mTc-human immunoglobulin (HIG)-first results of a new agent for the localization of infection and inflammation. Eur J Nucl Med 16 (8–10): 649–655

    Google Scholar 

  7. Goldenberg DM, Larson SM (1992) Radioimmunodetection in cancer identification. J Nucl Med 33 (5): 803–814

    Google Scholar 

  8. Gratz S, Behr T, Schmitt HA, Wüstner M, Morguet A, Mellerand J, Becker W (1998) Tc-99m-labeled antigranulocyte monoclonal antibody Fab′ fragments (LeukoScan®) for diagnostic imaging of bone and soft tissue infections. J Nucl Med 39 [Suppl]: 34

    Google Scholar 

  9. Hakki S, Harwood SJ, Morissey MA, Camblin JG, Laven DL, Webster WB (1997) Comparative study of monoclonal antibody scan in diagnostic orthopaedic infection. Clin Orthop 335: 275–285

    Google Scholar 

  10. Hansen HJ, Goldenberg DM, Newman ES, Grebenau R, Sharkey RM (1993) Characterization of second-generation monoclonal antibodies against carcinoembryonic antigen. Cancer 71 (11): 3478–3485

    CAS  PubMed  Google Scholar 

  11. Hanssen AD, Rand JA (1999) Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 48: 111–122

    CAS  PubMed  Google Scholar 

  12. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51 (4): 737—755

    CAS  PubMed  Google Scholar 

  13. Jessup JM, Kim JC, Thomas P et al. (1993) Adhesion to carcinoembryonic antigen by human colorectal carcinoma cells involves at least two epitopes. Int J Cancer 55 (2): 262–268

    Google Scholar 

  14. Klett R, Khalisi A, Haas H, Puille M, Steiner D, Stürz H, Bauer R (2001) Stufendiagnostik septischer Hüftendoprothesenlockerungen mittels Laborparametern und Antigranulozytenszintigraphie. Z Orthop 139: 415–419

    Google Scholar 

  15. Kordelle J, Klett R, Stahl U, Sternkopf U, Haas H, Jürgensen I, Schleicher I (2003) Stufendiagnostik bei postinfektiöser Hüft- und Knie-TEP-Implantation: Aussagekraft von Laborparametern und Antigranulozytenszintigraphie. Z Orthop 141: 547–553

    Google Scholar 

  16. Mangram AJ, Horan TC, Pearson ML et al. (1999) Guideline for prevention of surgical infection. Centers for Disease Control and Prevention Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27: 97–132

    Google Scholar 

  17. Mirra JM, Amstutz HC, Matos MM, Gold R (1976) The pathology of the joint tissues and its clinical relevance in prosthesis failure. Clin Orthop 117: 221–240

    Google Scholar 

  18. Nagel G, Grunert F (1995) From genes to proteins: the nonspecific cross-reacting antigens. Tumour Biol 16 (1): 17–22

    Google Scholar 

  19. Oyen WJ, Claessens RA, van Horn JR, van der Meer JW, Corstens FH (1990) Scintigraphic detection of bone and joint infections with indium-111-labeled nonspecific polyclonal human immunoglobulin G. J Nucl Med 31 (4): 403–412

    Google Scholar 

  20. Pandey R, Drakoulakis E, Athanasou NA (1999) An assessment of the histological criteria used to diagnose infection in hip revision arthroplasty tissues. J Clin Pathol 52: 118–123

    CAS  PubMed  Google Scholar 

  21. Peters AM, Danpure HJ, Osman S et al. (1986) Clinical experience with99mTc-hexamethylpropylene-amineoxime for labelling leucocytes and imaging inflammation. Lancet 2 (8513): 946–949

    Article  CAS  PubMed  Google Scholar 

  22. Rojas Burke J (1992) Health officials reacting to infections mishaps. J Nucl Med 33: 13–27

    Google Scholar 

  23. Schauwecker DS (1989) Osteomyelitis: diagnosis with In-111-labeled leukocytes. Radiology 171 (1): 141–146

    Google Scholar 

  24. Spangehl MJ, Masri BA, O’Connell JX et al. (1999) Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am 81: 672–683

    Google Scholar 

  25. Spangehl MJ, Younger AS, Masri BA et al. (1998) Diagnosis of infection following total hip arthroplasty . Instr Course Lect 47: 285–295

    CAS  PubMed  Google Scholar 

  26. Widmer AF (2001) New developments in diagnosis and treatment of infection in orthopedic implants. Clin Infect Dis 33 [Suppl 2]: 94–106

    Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Orthopädische Klinik, Universitätsklinikum, Patras, Griechenland

    A. Kaisidis, P. Megas, P. Zouboulis & E. Lambiris

  2. Abteilung für Nuklearmedizin, Universitätsklinikum, Patras, Griechenland

    D. Apostolopoulos, T. Spiridonidis & P. Vassilakos

  3. Abteilung für Pathologische Anatomie, Universitätsklinikum, Patras, Griechenland

    D. Koumoundourou

  4. Orthopädische Klinik, Universitätsklinikum, 26504, Rio-Patras, Griechenland

    A. Kaisidis

Authors
  1. A. Kaisidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Megas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Apostolopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Spiridonidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Koumoundourou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Zouboulis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Lambiris
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Vassilakos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Kaisidis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kaisidis, A., Megas, P., Apostolopoulos, D. et al. Diagnose septischer Hüftprothesenlockerung via LeukoScan. Orthopäde 34, 462–469 (2005). https://doi.org/10.1007/s00132-005-0777-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-005-0777-x

Schlüsselwörter

Keywords

Search

Navigation