An evaluation of the role of nuclear medicine imaging in the diagnosis of periprosthetic infections of the hip

•Nuclear Medicine can accurately diagnose periprosthetic infection.•NM has an integral role in the rational management of periprosthetic infection.•SPECT CT has a potential role in improving accuracy.

AimTo validate the role of nuclear medicine (NM) imaging in hip periprosthetic joint infection (PJI) of hip arthroplasties.Materials and methodsThis was a retrospective study of 235 consecutive patients referred to NM for investigation of a symptomatic hip prosthesis. Imaging comprised Tc-99m bone scintigraphy, In-111 white cell scintigraphy, and bone marrow scintigraphy if required. Imaging findings were compared with intraoperative microbiology and histology, clinical findings and follow up for ≥24 months.ResultsThere were 14 exclusions. Of the 221 remaining patients, there were 16 true positives, one false positive, 200 true negatives, and four false negatives. The algorithm used at this centre demonstrated an accuracy of 97.7% with high specificity of 99.5% and sensitivity of 80%.ConclusionWhen modern NM techniques and accurate reporting criteria are used, scintigraphy is an effective tool for diagnosing PJI of the hip. NM is only given a marginal role in the recent American Association of Orthopedic Surgeons guidelines, and the orthopaedic community should reconsider their evaluation of this technique.