A serious complication of
joint replacement surgery is
infection, which results in prolonged invalidity as well as removal and subsequent re-implantation after lengthy
antibiotic therapy. In terms of diagnostic imaging, nuclear medicine has presented several tracers and imaging modalities over the years to be used in prosthetic joint
infection. The PubMed/MEDLINE literature database was systematically examined for publications on
infection,
arthroplasty,
joint replacement, prosthetic joint,
gallium, labeled leukocytes,
sulfur colloid,
antimicrobial peptides,
Fluorine-18-fluorodeoxyglucose ((18)F-FDG), positron emission tomography/computed tomography (PET-CT), and single-photon emission (SPET-CT). This was determined to be a comprehensive review, not a meta-analysis of prosthetic joint
infection and diagnostic imaging in the field of nuclear medicine. Prosthetic
joint replacement is more frequently being employed as a way of improving the quality of life in an ever-ageing population. Complications following
joint replacement surgery include aseptic or mechanical loosening, as well as
polyethylene wear and prosthetic joint
infection. The rate of
infection is estimated to be between 1%-3%. The therapeutic management of these complications lies in the ability to differentiate between
infection and aseptic mechanical loosening. Given that plain radiographs are neither sensitive nor specific to
infection and computer tomography, as well as magnetic resonance imaging are limited due to
metal-induced artifacts,
radionuclide imaging has come to aid in the diagnostic imaging in the failed
joint replacement. However, each modality has its advantages and disadvantages, thus there is no gold standard technique of
radionuclide imaging. Nevertheless, radiolabelled leukocyte scintigraphy has proven itself to be the gold standard in neutrophil-based
infection processes. Several studies have examined the role of PET using radiotracers such as (18)F-FDG,
gallium-67 and (18)F, as well as SPET-CT in diagnosing prosthetic joint
infections. Other radiotracers, such as antigranulocyte
antibodies and fragments, as well as radiolabeled
antibodies and
antimicrobial peptide have yet to confirm their role in diagnostic imaging of the failed
joint replacement. Nuclear medicine plays a vital role in diagnosing prosthetic joint
infections. WBC/bone marrow imaging is the best available diagnostic imaging test. Newer imaging modalities, such as SPET-CT may in the future, play a larger role in diagnosing prosthetic joint
infections. The roles of (18)F-PET and (18)F-FDG-PET have yet to still be determined.