Diagnostic performance of SPECT/CT for identification of aseptic loosening after total knee and hip arthroplasty: a systematic review and meta-analysis

Keywords:

Total knee arthroplasty, total hip arthroplasty, single-photon emission computed tomography, computed tomography, meta-analysis, Aseptic loosening


Published online: Jan 22 2025

https://doi.org/10.52628/90.3.12562

S. TALEBI1, E. RAHMANI2, M. ABDINEJAD3, M. AHMADZADE4, B. HOORSHAD5, A. M. FARD5, T. M. FARD6, A. SHAFIGH6, H. MOMENI8, N. RADPOUR9, F. AFRAZEH8, S. SEYDIPOUR5, S.-G. SHAFAGH6, E. SHABANI10, B.K. SHAHRAKI5, M. KHODASHENAS11, H. JALAYERI6, M. FARROKHI12, S. M. KAZEMI13

1 Department of Orthopedics, Isfahan University of Medical Sciences, Isfahan, Iran
2 Graduated, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Nuclear Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
4 Pardis Noor Medical Imaging Center, Tehran, Iran
5 ERIS Research Institute, Tehran, Iran
6 Graduated, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
7 Graduated, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
8 Graduated, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
9 Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
10 Graduated, School of Medicine, Mashhad Azad University of Medical Sciences, Mashhad, Iran
11 Graduated, School of medicine, Alborz University of Medical Sciences, Karaj, Iran
12 Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
13 Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Despite an increasing number of studies examining the effect of Single-Photon Emission Computed Tomography/ Computed Tomography (SPECT/CT) on improvement of diagnosis of aseptic loosening, there is still a great deal of uncertainty regarding its applicability in diagnostic algorithm. Therefore, in this meta-analysis, we aimed to investigate the diagnostic performance of SPECT/CT for identification of aseptic loosening in patients with persistent pain following the total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Electronic databases including Medline, Scopus, Web of Science, Cochrane library, and Embase were systematically searched for identifying relevant published studies from their inception to April 2023. Quality evaluation of the included studies was carried out using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).

SPECT/CT had pooled sensitivity of 94% (95% CI: 92-95%) and pooled specificity of 86% (95% CI: 83-89%) for diagnosis of aseptic loosening. The pooled positive likelihood ratio (LR) was estimated as 6.92 (95% CI: 3.74-12.81), the pooled negative LR was estimated as 0.1 (95% CI: 0.06-0.16), and the pooled diagnostic odds ratio (DOR) was estimated as 89.82 (95% CI: 33.04- 244.21). The Summary receiver operating characteristics (SROC) analysis revealed high accuracy with an area under curve (AUC) of 0.96.

The findings of this meta-analysis revealed that SPECT/CT has high sensitivity and specificity for diagnosis of aseptic loosening in patients who underwent TKA or THA. Therefore, SPECT/CT can be considered as an encouraging diagnostic adjunct, particularly in cases with uncertain results of bone scan.

ActaOrthopBelg-90-3-cover

About this issue

Volume 90, issue 3.

Sep 2024.

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