TY - JOUR

T1 - Labeled white blood cell/bone marrow single-photon emission computed tomography with computed tomography fails in diagnosing chronic periprosthetic shoulder joint infection

AU - Falstie-Jensen, Thomas

AU - Daugaard, Henrik

AU - Søballe, Kjeld

AU - Ovesen, Janne

AU - Arveschoug, Anne Kirstine

AU - Lange, Jeppe

AU - ROSA study group

A2 - Zerahn, Bo

N1 - Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

PY - 2019/6

Y1 - 2019/6

N2 - BACKGROUND: Shoulder periprosthetic joint infections (PJI) caused by low-virulent bacteria pose a diagnostic challenge. Combined labeled leukocyte (WBC) and technetium 99m sulfur colloid bone marrow imaging (WBC/BM) is considered the radionuclide imaging gold standard for diagnosing lower limb PJI. However, it is laborious and expensive to perform, and documentation on shoulder arthroplasties is lacking. This study investigated WBC/BM single-photon emission computed tomography-computed tomography diagnostic performance in shoulder PJI.METHOD: All patients with a failed arthroplasty referred to a highly specialized shoulder department were scheduled for a diagnostic program including a WBC/BM. If an arthroplasty was revised, biopsy specimens were obtained and cultured for 14 days. The diagnostic performance of WBC/BM imaging was determined using biopsy specimens as a reference.RESULTS: Of the 49 patients who underwent a WBC/BM scan, 29 (59%) were revised. Infection was present in 11 patients, in whom 2 WBC/BM scans were true positive. The WBC/BM scan in 9 patients was false negative. The remaining 18 patients all had a true negative WBC/BM scan. WBC/BM showed a sensitivity 0.18 (95% confidence interval [CI], 0.00-0.41) and specificity 1.00 (95% CI, 1.00-1.00) in detecting shoulder PJI. The positive predictive value was 1.00 (95% CI, 1.00-1.00), and negative predictive value was 0.67 (95% CI, 0.49-0.84). No patients infected with Cutibacterium (formerly Propionibacterium) acnes resulted in a positive WBC/BM, nor had they preoperative or perioperative signs of infection.CONCLUSION: A positive WBC/BM was found only in patients with obvious PJI. Hence, the scan added nothing to the preoperative diagnosis. The WBC/BM single-photon emission computed tomography-computed tomography scan cannot be recommended as a screening procedure when evaluating failed shoulder arthroplasties for possible infection.

AB - BACKGROUND: Shoulder periprosthetic joint infections (PJI) caused by low-virulent bacteria pose a diagnostic challenge. Combined labeled leukocyte (WBC) and technetium 99m sulfur colloid bone marrow imaging (WBC/BM) is considered the radionuclide imaging gold standard for diagnosing lower limb PJI. However, it is laborious and expensive to perform, and documentation on shoulder arthroplasties is lacking. This study investigated WBC/BM single-photon emission computed tomography-computed tomography diagnostic performance in shoulder PJI.METHOD: All patients with a failed arthroplasty referred to a highly specialized shoulder department were scheduled for a diagnostic program including a WBC/BM. If an arthroplasty was revised, biopsy specimens were obtained and cultured for 14 days. The diagnostic performance of WBC/BM imaging was determined using biopsy specimens as a reference.RESULTS: Of the 49 patients who underwent a WBC/BM scan, 29 (59%) were revised. Infection was present in 11 patients, in whom 2 WBC/BM scans were true positive. The WBC/BM scan in 9 patients was false negative. The remaining 18 patients all had a true negative WBC/BM scan. WBC/BM showed a sensitivity 0.18 (95% confidence interval [CI], 0.00-0.41) and specificity 1.00 (95% CI, 1.00-1.00) in detecting shoulder PJI. The positive predictive value was 1.00 (95% CI, 1.00-1.00), and negative predictive value was 0.67 (95% CI, 0.49-0.84). No patients infected with Cutibacterium (formerly Propionibacterium) acnes resulted in a positive WBC/BM, nor had they preoperative or perioperative signs of infection.CONCLUSION: A positive WBC/BM was found only in patients with obvious PJI. Hence, the scan added nothing to the preoperative diagnosis. The WBC/BM single-photon emission computed tomography-computed tomography scan cannot be recommended as a screening procedure when evaluating failed shoulder arthroplasties for possible infection.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Arthroplasty, Replacement, Shoulder/adverse effects

KW - Cohort Studies

KW - Female

KW - Humans

KW - Leukocytes

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Prosthesis-Related Infections/blood

KW - Sensitivity and Specificity

KW - Shoulder Prosthesis/adverse effects

KW - Tomography, Emission-Computed

KW - Tomography, X-Ray Computed

U2 - 10.1016/j.jse.2018.10.024

DO - 10.1016/j.jse.2018.10.024

M3 - Journal article

VL - 28

SP - 1040

EP - 1048

JO - Journal of Shoulder and Elbow Surgery

JF - Journal of Shoulder and Elbow Surgery

SN - 1058-2746

IS - 6

ER -