Table 1 Characteristics of the included studies
Author and reference | N | Type of study | Level of evidence | Type of arthroplasty | Radiotracer | Administration | Reference test | Sensitivity | Specificity | Conclusions |
|---|---|---|---|---|---|---|---|---|---|---|
Abele et al. [39] | 17 | Diagnostic retrospective | III | TKA | 99mTc Sulf Colloid | i.a | Intraoperative, follow-up | 0.67 | 0.93 | SPECT/CT arthrography with high accuracy for detecting loosening in painful knee arthroplasty |
Al-Nabhani et al. [40] | 24 | Diagnostic retrospective | III | TKA | 99mTc HDP | i.v | Intraoperative, follow-up | 0.90 | 0.80 | Changed initial diagnosis in 85% of patients. SPECT/CT identified correctly loosening and excluded other causes |
Arican et al. [41] | 30 | Diagnostic retrospective | III | TKA | 99mTc MDP | i.v | Intraoperative | 0.87–0.93 | 100 | Showed different SPECT/CT operative characteristics according to the anatomical place of the knee replacement. Better diagnostic performance for tibial component. A negative result excluded with high accuracy a pathological condition |
Bao et al. [42] | 36 | Diagnostic retrospective | III | TKA | 99mTc Sulf Colloid | i.a | Intraoperative, follow-up | 0.50 | 0.97 | SPECT/CT arthrography showed high accuracy for detecting loosening in painful knee arthroplasty and excluding pathological condition. They showed that a detection of tracer activity along the bone interface was related to aseptic loosening |
Chew et al. [43] | 44 | Diagnostic retrospective | III | TKA | 99mTc Ca Phyt | i.a | Intraoperative | 0.75–0.86 | 0.63–0.86 | They reported different diagnostic performance values according to the anatomical place of the knee replacement. Better diagnostic performance for tibial component. A negative result excluded with high accuracy a pathological condition. They demonstrated superiority of SPECT/CT when it was compared with planar images in bone scan images |
Hirschmann et al. [44] | 33 | Diagnostic prospective | II | TKA | 99mTc HDP | i.v | Intraoperative | 0.91 | 0.96 | Confirmed loosening and patellofemoral disorders in all patients. They reported 1 false negative result in a patient with membrane within the interphase bone-metal. They highlighted how typical patterns of BTU significantly correlated with loosening of the components. SPECT/CT changed the clinical diagnosis in 85% of the patients |
Mandegaran et al. [45] | 41 | Diagnostic retrospective | III | TKA | 99mTc MDP | i.v | Intraoperative, follow-up | 0.93 | 0.79 | SPECT/CT demonstrated additional potential aetiologies in 43% of patients: heterotopic ossification, biomechanical stress, periprosthetic fracture, degenerative patellofemoral diseases |
Murer et al. [46] | 83 | Diagnostic retrospective | III | TKA | 99mTc HDP | i.v | Intraoperative | 0.43–0.98 | 0.93–0.99 | SPECT/CT changed the initial diagnosis in 65% of the patients. They provided different underlying causes of persistent knee pain after TKA and helped to identify clinically unsuspected origin of pain. They reported different values of operative characteristics according to different place of the knee replacement, highlighting the best values for tibial component and patellar structure |