Correlation of typical pain patterns with bone tracer uptake in SPECT/CT in patients with pain after total knee arthroplasty
ESSKA Academy. MATHIS D. 11/08/19; 286408 Topic: G4 - Tricompartmental (Simple) arthroplasty
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Correlation of typical pain patterns with bone tracer uptake in SPECT/CT in patients with pain after total knee arthroplasty

EKA Free Papers

Topic: TKA

Mathis D.1, Tschudi S.1, Amsler F.2, Rasch H.1, Hirschmann M.1
1Kantonsspital Baselland, Bruderholz, Switzerland, 2Amsler Consulting, Basel, Switzerland

Introduction: About 20% of patients after total knee arthroplasty (TKA) are not satisfied nor pain free. After a challenging diagnostic workup it is not unusual that revision surgery becomes necessary. There is a general consensus that knee revision surgery should only be performed when the causes of the complaints are identified. Over the past years it has been shown that SPECT/CT can influence the decision-making significantly. Further the detection of pain patterns that are typical for specific pathologies is paramount. Revision surgeons are well aware of some pain patterns as well as bone tracer uptake (BTU) patterns in SPECT/CT but to date there is no study dealing with identification of typical pain and BTU patterns in patients with painful TKA.
Objectives: To identify typical pain and BTU patterns in patients with painful TKA.
Aims: To assign pain and BTU patterns to typical pathologies such as instability, stiffness, loosening, patellofemoral overstuffing and mechanical dysfunctions.
Methods: A consecutive number of 129 patients, which were seen in the consultation at a specialized knee centre due to painful primary TKA and whose diagnostic workup resulted in revision surgery were included. Defined criteria were retrospectively assessed from pre-existing patient documentation (localisation, intensity and character of pain; demographic data) and SPECT/CT data (BTU activity-level, position of the TKA-components), statistic analysis (chi-squared test) and the assignment to the underlying pathology was performed.
Results: Typical pain patterns were defined and assigned to specific pathologies. Significant correlation was shown between localisation, intensity and character of pain and demographic data, type and position of the prosthetic components, surgical technique as well as the underlying cause for revision surgery such as instability, stiffness, loosening, patellofemoral overstuffing and mechanical dysfunction. Further correlation with specific BTU patterns were shown.
Conclusion: The detection and definition of typical pain and BTU patterns in patients with pain after TKA and the assignment of identified pathologies will be applied in the improvement of the diagnostic process. Only when the exact cause of pain is determined, the therapy can be successful. The results of this study allow improving the clinical diagnostic process of patients with pain after TKA and help to enhance the indications for possible revision surgery.
Correlation of typical pain patterns with bone tracer uptake in SPECT/CT in patients with pain after total knee arthroplasty

EKA Free Papers

Topic: TKA

Mathis D.1, Tschudi S.1, Amsler F.2, Rasch H.1, Hirschmann M.1
1Kantonsspital Baselland, Bruderholz, Switzerland, 2Amsler Consulting, Basel, Switzerland

Introduction: About 20% of patients after total knee arthroplasty (TKA) are not satisfied nor pain free. After a challenging diagnostic workup it is not unusual that revision surgery becomes necessary. There is a general consensus that knee revision surgery should only be performed when the causes of the complaints are identified. Over the past years it has been shown that SPECT/CT can influence the decision-making significantly. Further the detection of pain patterns that are typical for specific pathologies is paramount. Revision surgeons are well aware of some pain patterns as well as bone tracer uptake (BTU) patterns in SPECT/CT but to date there is no study dealing with identification of typical pain and BTU patterns in patients with painful TKA.
Objectives: To identify typical pain and BTU patterns in patients with painful TKA.
Aims: To assign pain and BTU patterns to typical pathologies such as instability, stiffness, loosening, patellofemoral overstuffing and mechanical dysfunctions.
Methods: A consecutive number of 129 patients, which were seen in the consultation at a specialized knee centre due to painful primary TKA and whose diagnostic workup resulted in revision surgery were included. Defined criteria were retrospectively assessed from pre-existing patient documentation (localisation, intensity and character of pain; demographic data) and SPECT/CT data (BTU activity-level, position of the TKA-components), statistic analysis (chi-squared test) and the assignment to the underlying pathology was performed.
Results: Typical pain patterns were defined and assigned to specific pathologies. Significant correlation was shown between localisation, intensity and character of pain and demographic data, type and position of the prosthetic components, surgical technique as well as the underlying cause for revision surgery such as instability, stiffness, loosening, patellofemoral overstuffing and mechanical dysfunction. Further correlation with specific BTU patterns were shown.
Conclusion: The detection and definition of typical pain and BTU patterns in patients with pain after TKA and the assignment of identified pathologies will be applied in the improvement of the diagnostic process. Only when the exact cause of pain is determined, the therapy can be successful. The results of this study allow improving the clinical diagnostic process of patients with pain after TKA and help to enhance the indications for possible revision surgery.
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