Background: The diagnosis of hip pain after total hip replacement (THR) represents a highly challenging question\nthat is of increasing concern to orthopedic surgeons. This retrospective study assesses bone scintigraphy with\nHybrid SPECT/CT for the diagnosis of painful THR in a selected cohort of patients.\nMethods: Bone SPECT/CT datasets of 23 patients (mean age 68.9 years) with a painful hip after THR were\nevaluated. Selection of the patients required an inconclusive radiograph, normal serum levels of inflammatory\nparameters (CRP and ESR) or a negative aspiration of the hip joint prior to the examination. The standard of\nreference was established by an interdisciplinary adjudication-panel using all imaging data and clinical follow-up\ndata (>12 month). Pathological and physiological uptake patterns were defined and applied.\nResults: The cause of pain in this study group could be determined in 18 out of 23 cases. Reasons were aseptic\nloosening (n = 5), spine-related (n = 5), heterotopic ossification (n = 5), neuronal (n = 1), septic loosening (n = 1) and\nperiprosthetic stress fracture (n = 1). In (n = 5) cases the cause of hip pain could not be identified. SPECT/CT imaging\ncorrectly identified the cause of pain in (n = 13) cases, in which the integrated CT-information led to the correct\ndiagnosis in (n = 4) cases, mainly through superior anatomic correlation. Loosening was correctly assessed in all\ncases with a definite diagnosis.\nConclusions: SPECT/CT of THA reliably detects or rules out loosening and provides valuable information about\nheterotopic ossifications. Furthermore differential diagnoses may be detected with a whole-body scan and mechanical\nor osseous failure is covered by CT-imaging. SPECT/CT holds great potential for imaging-based assessment of\npainful prostheses.
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