Knee最新文献

{"title":"Does a medial congruent bearing in total knee arthroplasty compromise fixation? A randomized controlled trial","authors":"Kristian R.L. Mortensen ,&nbsp;Lina Holm Ingelsrud ,&nbsp;Omar Muharemovic ,&nbsp;Kirill Gromov ,&nbsp;Anders Troelsen","doi":"10.1016/j.knee.2024.11.015","DOIUrl":"10.1016/j.knee.2024.11.015","url":null,"abstract":"<div><h3>Background</h3><div>Medially congruent (MC) bearings aim at promoting medial pivoting after total knee arthroplasty (TKA), as the congruency provides further constraint for the medial femoral compartment. However, this design difference could alter intra-articular force distribution, potentially compromising fixation of the tibia implant. The aim of this study was to compare migration, measured with radiostereometric analysis (RSA), of an MC to a more traditional cruciate retaining (CR) TKA system. Secondary aims were to compare patient-perceived treatment outcome and number of complications between the treatment groups.</div></div><div><h3>Methods</h3><div>Sixty patients undergoing TKA were randomized to an MC or CR bearing and had follow up visits after 3 months, 1 and 2 years. Primary outcome was tibia implant migration, measured by maximal total point motion (MTPM) with model-based RSA, 2 years post-surgery. Secondary outcomes were tibia MTPM, change in patient-reported outcome measurements (PROMs) and number of complications registered at all follow up visits.</div></div><div><h3>Results</h3><div>Primary outcome was available for 52 patients (27 MC patients, 25 CR patients). We found no difference in tibia MTPM between the MC and CR groups 2 years post-surgery. Median (interquartile range) MTPM was 0.60 (0.39–0.97) mm and 0.48 (0.32–0.78) mm in the MC and CR group, respectively (<em>P</em> = 0.167). There were no between-group differences in improvement in PROMs and no between-group differences in number of complications.</div></div><div><h3>Conclusion</h3><div>We found no compromising of tibia implant fixation in TKA by choosing an MC bearing, when compared with a CR bearing. PROMs and complication rates suggest comparable treatment results with both types of bearings in TKA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 19-27"},"PeriodicalIF":1.6,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of microvascular density and collagen structure of the medial meniscotibial ligament of the knee: Immunohistochemical study with CD31 and histology with Picrosirius red","authors":"Amanda Progenio dos Santos ,&nbsp;Jonatas Brito de Alencar Neto ,&nbsp;Pedro Henrique Marques Amorim ,&nbsp;Paulo Goberlânio de Barros Silva ,&nbsp;Maria Luzete Costa Cavalcante","doi":"10.1016/j.knee.2024.11.016","DOIUrl":"10.1016/j.knee.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div>The aim of the present study was to describe the structure of the collagen matrix and the microvascularization of the medial meniscotibial ligament (MMTL), in order to contribute to the refinement of the surgical technique for repairing these structures and consequently lead to a reduction in the risk of anterior cruciate ligament re-rupture.</div></div><div><h3>Methods</h3><div>Twelve MMTLs were obtained from deceased organ donors. The ligaments were initially analyzed macroscopically and evaluated histologically using hematoxylin and eosin staining. The evaluation of the collagen matrix was carried out using the Picrosirius red staining method under a polarized light microscope. Immunohistochemical study using monoclonal antibodies against CD31 was used to evaluate microvascularization.</div></div><div><h3>Results</h3><div>The MMTL was identified in 100% of the dissections. The hematoxylin and eosin-stained histological sections exhibited oriented and parallel collagen fibers, with low cellularity in its intrasubstance portion and increase in cellularity close to the meniscal insertion. Quantitative analysis of the collagen matrix showed a ratio of type I to type III collagen of 3.86 (±3.07). The average microvascular density in the intrasubstance portion was 33.71 ± 8.7 vessels/mm² and in the meniscal insertion portion it was 74.14 ± 23.85 vessels/mm².</div></div><div><h3>Conclusion</h3><div>The MMTL is a structure with a predominance of Type I collagen in relation to Type III collagen and high microvascular density in the region of meniscal insertion. These findings suggest that the healing potential of MMTL, regarding ramp injuries, is high because these injuries occur in the meniscal insertion area.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 10-18"},"PeriodicalIF":1.6,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcome and complications after simultaneous bilateral medial opening-wedge high tibial osteotomy","authors":"Kyung Wook Nha ,&nbsp;Hyung Suh Kim ,&nbsp;Jong Min Kim ,&nbsp;Tulyapruek Tawonsawatruk ,&nbsp;Sang-Gyun Kim","doi":"10.1016/j.knee.2024.11.012","DOIUrl":"10.1016/j.knee.2024.11.012","url":null,"abstract":"<div><h3>Background</h3><div>The literature provides limited evidence regarding postoperative outcomes and complications following simultaneous bilateral medial opening-wedge high tibial osteotomy (MOWHTO). This study aimed to investigate the clinical outcomes and complications associated with simultaneous bilateral MOWHTO.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated 72 knees from 36 patients (mean age, 58.6 ± 8.2 years) who underwent simultaneous bilateral MOWHTOs between December 2011 and January 2021. Locking compression plates were used for simultaneous bilateral MOWHTOs. The Oxford Knee Score (OKS) was used to assess clinical outcomes at the last follow up. Complications (lateral hinge fracture (LHF), nonunion, and loss of correction) were evaluated using postoperative serial plain radiography and computed tomography (CT).</div></div><div><h3>Results</h3><div>At the last follow up (range, 2.0–11.1 years), the mean OKS for the 72 knees was 36.8 ± 10.4. According to the OKS, 42 knees (58.3%) scored ’excellent’, 16 (22.2%) scored ‘good’, eight (11.1%) scored ‘moderate’, and six (8.3%) scored ‘poor’. LHFs occurred in 11 of the 72 knees (15.3%). Among these, five LHFs were identified on postoperative plain radiographs and CT scans (acute LHFs), whereas six fractures were identified only on follow up plain radiographs (delayed LHFs). Loss of correction occurred in one patient with delayed LHFs. The patient required an additional surgical treatment to achieve bone healing at the osteotomy site.</div></div><div><h3>Conclusion</h3><div>Simultaneous bilateral MOWHTO is a viable treatment option for patients with bilateral medial osteoarthritis of the knee joint. Serial plain radiographs at short-term intervals are recommended to detect delayed LHFs and prevent complications such as fixation failure and loss of correction.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 230-237"},"PeriodicalIF":1.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Budgets, costs and deprivation","authors":"Caroline Hing (Editor-in-chief),&nbsp;Oday Al-Dadah (Editor-in-chief)","doi":"10.1016/j.knee.2024.11.010","DOIUrl":"10.1016/j.knee.2024.11.010","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"51 ","pages":"Pages A1-A2"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning is better than surgeons at assessing unicompartmental knee replacement radiographs","authors":"S Jack Tu ,&nbsp;Sara Kendrick ,&nbsp;Karthik Saravanan ,&nbsp;Christopher Dodd ,&nbsp;David W Murray ,&nbsp;Stephen J Mellon","doi":"10.1016/j.knee.2024.11.007","DOIUrl":"10.1016/j.knee.2024.11.007","url":null,"abstract":"<div><h3><strong>Background:</strong></h3><div>Poor results occasionally occur after unicompartmental knee replacement (UKR). It is often difficult, even for experienced surgeons, to determine why patients have poor outcomes from radiographs. The aim was to compare the ability of experienced surgeons and machine learning to predict whether patients had poor or excellent outcomes from radiographs.</div></div><div><h3><strong>Methods:</strong></h3><div>924 one-year anterior-posterior radiographs post-UKR were used to train a machine learning model (ResNet50v2) with a transfer learning approach based on their one-year Oxford Knee Score categories. Two experienced surgeons and the model assessed and categorised 70 radiographs (14 Poor scores; 56 Excellent scores) not used for training according to their expected outcome.</div></div><div><h3><strong>Results:</strong></h3><div>The ResNet50v2 model correctly identified 71% (n = 10) of the patients with a poor score and 46 (82%) of those with an excellent score. In contrast, one surgeon could not identify patients with Poor scores (0%) and the other identified one (7%). Both misidentified 3 of those with Excellent scores. The model visualisation method suggested that estimated classifications were made from image features around the implants.</div></div><div><h3><strong>Conclusion:</strong></h3><div>The results suggest that there are radiographical features that relate to poor outcomes, which the surgeons are unaware of. Those the model did not identify may have an extra-articular cause for their poor outcome. Further analysis to identify the features associated with poor outcomes could potentially suggest ways that indications or techniques could be improved so as to decrease the incidence of poor results.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 212-219"},"PeriodicalIF":1.6,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inferior short-term survivorship and patient outcomes for cementless compared to hybrid fixation with a cemented femoral implant in a novel blade-anchored medial unicompartmental knee arthroplasty design: An analysis of 132 cases","authors":"Roderick J.M. Vossen ,&nbsp;Lindsey V. Ruderman ,&nbsp;Jonathan Spaan ,&nbsp;Tarik Bayoumi ,&nbsp;Edwin Su ,&nbsp;Andrew D. Pearle","doi":"10.1016/j.knee.2024.11.008","DOIUrl":"10.1016/j.knee.2024.11.008","url":null,"abstract":"<div><h3>Purpose</h3><div>For younger, more active patients, a cementless unicompartmental knee arthroplasty (UKA) might be more advantageous than cemented fixation. Therefore, this study aimed to compare implant survivorship and patient-reported outcome measures (PROMs) between cementless and hybrid fixation (cemented femur and cementless tibial fixation) in a novel tibial blade-anchored, medial UKA design.</div></div><div><h3>Methods</h3><div>Two surgeon’s registries were reviewed for patients who underwent primary cementless or hybrid medial UKA for medial osteoarthritis between 2019 and 2022. Patients were included if implant survivorship and one-year postoperative PROMs (UCLA-activity score, Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR), pain (VAS) and satisfaction) were registered. Variables were compared using independent two-sample t-tests or the Chi-square test. Survival rates were determined using the Kaplan-Meier models and compared using the Log-rank test.</div></div><div><h3>Results</h3><div>A total of 132 knees were included (cementless 58.3%; cemented 41.7%; mean follow-up 3.1 ± 0.6 years). Three-year all-cause revision survival rate was significantly superior for the hybrid fixation (hybrid: 100%; cementless 88.5%[84.7%–92.3%], p = 0.026). However, the difference in three-year conversion rate to total knee arthroplasty (TKA) did not reach statistical significance. The one-year postoperative OKS (hybrid: 42.9 ± 4.8; cementless: 39.8 ± 6.4, p = 0.003) and KOOS-JR (hybrid:81.5 ± 13.7; cementless: 74.4 ± 12.1, p = 0.002) were significantly superior for the hybrid fixation. Three-year conversion rate to TKA and two-year postoperative PROMs did not significantly differ.</div></div><div><h3>Conclusion</h3><div>The cementless medial UKA demonstrated a significantly inferior short-term all-cause survival rate and inferior postoperative one-year OKS and KOOS-JR compared to the hybrid medial UKA design with a cemented femoral component.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 220-229"},"PeriodicalIF":1.6,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translation, cross-cultural adaptation, and clinimetric properties evaluation of the Danish version of the Anterior Cruciate Ligament – Return to Sport after Injury scale (ACL-RSI)","authors":"Andreas Bjerregaard ,&nbsp;Esben Kjeldgaard ,&nbsp;Kasper Nordahl Wøbbe ,&nbsp;Cecilie Køllner Olsen ,&nbsp;Kristoffer W Barfod ,&nbsp;Vasileios Korakakis","doi":"10.1016/j.knee.2024.11.001","DOIUrl":"10.1016/j.knee.2024.11.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To translate and cross-cultural adapt the Anterior Cruciate Ligament–Return To Sport After Injury (ACL-RSI) questionnaire into Danish (ACL-RSI-DK) and evaluate the psychometric properties with the purpose to identify the psychological readiness on returning to sport (RTS).</div></div><div><h3>Methods</h3><div>The ACL-RSI-DK followed a six-step translation and cultural-adaptation process. Statistical analysis included correlation for construct validity of the ACL-R-DK with the Lysholm, KOOS and K-SES. Moreover, we assessed reliability using Cronbach’s alpha and ICC and used Bland Atman methods to assess bias between test and re-test. An exploratory factor-analysis was used for the dimensionality of ACL-RSI-DK.</div></div><div><h3>Results</h3><div>102 Danish individuals (Female 49%, age 27.7 ± 7.3 years), 51.2 (±15.5) weeks post-op from anterior cruciate ligament reconstruction (ACLR) were included. The ACL-RSI-DK showed excellent internal consistency (Cronbach’s alpha 0.957) and test–retest reliability (ICC = 0.96), with no floor or ceiling effects. The Bland Atman analysis showed no systematic bias. The mean score was 48 ± 23 out of 100 points. The SEM was calculated to be 5/10 points and the MDC₉₅ was 13/100. The construct validity evaluation presented strong correlation between ACL-RSI-DK, K-SES (ρ = 0.63) and KOOS-Sport (ρ = −0.63), whereas a moderate correlation was found with Lysholm (ρ = 0.48) and KOOS (ρ = −0.58) and its subscales KOOS-Symptoms (ρ = −0.27), KOOS-Pain (ρ = −0.43), KOOS-ADL (ρ = −0.47) and KOOS-QoL (ρ = −0.59. ACL-RSI-DK was found to be an unidimensional scale with a total variance explained of 68.5%.</div></div><div><h3>Conclusion</h3><div>The ACL-RSI was successfully translated and cross-cultural adapted into Danish and displayed good psychometric properties. The ACL-RSI-DK is a valid and reliable tool to investigate the psychological readiness on RTS.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 203-211"},"PeriodicalIF":1.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between distal tibial rotation and clinical outcomes of medial open-wedge high tibial osteotomy","authors":"Chang-Wan Kim,&nbsp;Chang-Rack Lee,&nbsp;Yong-Uk Kwon,&nbsp;Soo-Hwan Jung,&nbsp;Hyun-Seung Lee","doi":"10.1016/j.knee.2024.11.009","DOIUrl":"10.1016/j.knee.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to evaluate the association between changes in knee joint geometry after medial open-wedge high tibial osteotomy (MOWHTO) and clinical outcomes.</div></div><div><h3>Methods</h3><div>This was a retrospective study of patients who underwent MOWHTO (101 knees) at our hospital between January 2015 and February 2022 and who were followed up for &gt; 2 years. Radiological and functional outcomes were compared between those who were satisfied with surgery (satisfaction group) and patients who were dissatisfied with surgery (dissatisfaction group). Multiple regression analysis was performed to analyze factors affecting the radiological parameters that significantly differed between the two groups.</div></div><div><h3>Results</h3><div>The average follow up period was 38.0 ± 15.4 months. There were no significant differences regarding demographic characteristics and preoperative radiological parameters between the satisfaction and dissatisfaction groups. There was a significant intergroup difference with respect to postoperative distal tibial rotation and change in distal tibial rotation (13.5 ± 4.8° and 9.5 ± 4.3°, respectively; <em>P</em> &lt; 0.001). The difference in tibial rotation before and after surgery was 4.3 ± 2.3° and 1.7 ± 1.8° in the dissatisfaction and satisfaction groups (<em>P</em> &lt; 0.001) Multiple regression analysis showed that the correction angle affected the distal tibial rotation in MOWHTO (<em>R²</em> = 0.079, ß = 0.165, <em>P</em> = 0.038).</div></div><div><h3>Conclusions</h3><div>In MOWHTO, an increase in distal tibial rotation was associated with patient dissatisfaction. Because the increase in distal tibial rotation is associated with a large correction angle, excessive distal tibial rotation should be avoided when MOWHTO requires a large correction angle.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 195-202"},"PeriodicalIF":1.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying performance and joint kinematics in functional tasks crucial for anterior cruciate ligament rehabilitation using smartphone video and pose detection","authors":"Nicolas Lambricht ,&nbsp;Alexandre Englebert ,&nbsp;Laurent Pitance ,&nbsp;Paul Fisette ,&nbsp;Christine Detrembleur","doi":"10.1016/j.knee.2024.11.006","DOIUrl":"10.1016/j.knee.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>The assessment of performance during functional tasks and the quality of movement execution are crucial metrics in the rehabilitation of patients with anterior cruciate ligament (ACL) injuries. While measuring performance is feasible in clinical practice, quantifying joint kinematics poses greater challenges. The aim of this study was to investigate whether smartphone video, using deep neural networks for human pose detection, can enable the clinicians not only to measure performance in functional tasks but also to assess joint kinematics.</div></div><div><h3>Methods</h3><div>Twelve healthy participants performed the forward reach of the Star Excursion Balance Test 10 times, along with 10 repetitions of forward jumps and vertical jumps, with simultaneous motion capture via a marker-based reference system and a smartphone. OpenPifPaf was utilized for markerless detection of anatomical landmarks in video recordings. The OpenPifPaf coordinates were scaled using anthropometric data of the thigh, and task performance and joint kinematics were computed for both the marker-based and markerless systems.</div></div><div><h3>Results</h3><div>Comparing results for marker-based and markerless systems revealed similar joint angles, with mean root mean square errors of 2.8° for the knee, 3.1° for the hip, and 3.9° for the ankle. Excellent agreement was observed for clinically pertinent parameters, i.e., the performance, the peak knee flexion, and the knee range of motion (intraclass correlation coefficient &gt; 0.97).</div></div><div><h3>Conclusion</h3><div>The results underscore the feasibility of using markerless methods based on OpenPifPaf for assessing performance and joint kinematics in functional tasks crucial for ACL patients’ rehabilitation. The simplicity of this approach makes it suitable for integration into clinical practice.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 171-178"},"PeriodicalIF":1.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SPECT-CT may aid in determining which side of a revision stemmed implant problematic total knee replacement is loose when planning revision surgery","authors":"Daniel Hill,&nbsp;Patrick Rogers,&nbsp;Jonathan Phillips,&nbsp;Ben Waterson,&nbsp;Andrew D. Toms","doi":"10.1016/j.knee.2024.10.016","DOIUrl":"10.1016/j.knee.2024.10.016","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate SPECT-CT in the diagnosis of single component aseptic loosening in patients with a problematic cemented stemmed TKR (Total Knee Replacement).</div></div><div><h3>Methods</h3><div>SPECT-CT was performed where aseptic loosening was suspected but was not clear on plain radiography. Demographics, suspected diagnosis and intention to revise were collected prospectively before and after SPECT-CT.</div></div><div><h3>Results</h3><div>30 patients were investigated. 43% (95% CI: 0.5–0.9) had clear evidence of loosening on SPECT-CT. In 23% (95% CI: 0.1–0.4) intention to perform revision surgery following SPECT-CT changed (7/30) (<em>p</em> = 0.0004, standard error = 42.1, <em>z</em> = 3.5).</div><div>Intentions to perform revision surgery according to the radiologist’s overall summary were:</div><div>Normal SPECT-CT – 0% (95% CI: 0.0–0.8) intention to revise (0/2).</div><div>Possibly abnormal SPECT-CT – 13% (95% CI: 0.0–0.4) intention to revise (2/15).</div><div>Definitely abnormal SPECT-CT – 77% (95% CI: 0.5–0.9) intention to revise (10/13).</div><div>We report that SPECT-CT had a test sensitivity of 90.9% (95% CI: 0.6–1.0), a specificity of 100% (95% CI: 0.9–1.0), a positive predictive value of 100% and a negative predictive value of 97.7%.</div><div>In 70% (95% CI: 0.3–0.9) of cases where revision surgery was performed for aseptic loosening SPECT-CT provided information that guided pre-operative planning with regards single component or both component revision surgery (7/10).</div></div><div><h3>CONCLUSION</h3><div>When positive SPECT-CT was useful in determining single component revision. A normal SPECT-CT may have a negative predictive value; however, overall half of our series had a possibly abnormal or equivocal investigation.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 179-194"},"PeriodicalIF":1.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}