Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty - a new dimension of diagnostics?

BACKGROUND: The purpose of our study was to evaluate the clinical value of hybrid SPECT/CT for the assessment of patients with painful total knee arthroplasty (TKA). METHODS: Twenty-three painful knees in patients following primary TKA were assessed using Tc-99m-HDP-SPECT/CT. Rotational, sagittal and coronal position of the TKA was assessed on 3D-CT reconstructions. The level of the SPECT-tracer uptake (0-10) and its anatomical distribution was mapped using a validated localization scheme. Univariate analysis (Wilcoxon-Mann-Whitney, Spearmean`s-rho test, p<0.05) was performed to identify any correlations between component position, tracer uptake and diagnosis. RESULTS: SPECT/CT imaging changed the suspected diagnosis and the proposed treatment in 19/23 (83%) knees. Progression of patellofemoral OA (n=11), loosening of the tibial (n=3) and loosening of the femoral component (n=2) were identified as the leading causes of pain after TKA. Patients with externally rotated tibial trays showed higher tracer uptake in the medial patellar facet (p=0.049) and in the femur (p=0.051). Patients with knee pain due to patellofemoral OA showed significantly higher tracer uptake in the patella than others (p<0.001). CONCLUSIONS: SPECT/CT was very helpful in establishing the diagnosis and guiding subsequent management in patients with painful knees after TKA, particularly in patients with patellofemoral problems and malpositioned or loose TKA.