Radionuclide model of dual time point imaging in the prediction of paraendoprosthetic complications in hip and joint arthroplasty
Background. In recent decades in the world, there has been an increase in the number of patients with deforming osteoarthritis of different etiologies from 19.8 to 63 %. In Ukraine, the prevalence of osteoarthritis is 2,200.6 per 100,000 population, in America - 6,500. At the same time, questions regarding the determination of bone scintigraphic parameters, which can be predicted in the preoperative period of parаprosthetic complications, with the aim of arthroplasty without the risk of their occurrence, remain incompletely studied. The purpose of the study was to determine the diagnostic role of radionuclide method in predicting paraprosthetic complications in patients with deforming osteoarthritis of the hip and knee joints, by redesigning the dual time point imaging scintigraphic model. Materials and methods. Three-phase bone scintigraphy was performed on a tomographic scintillation gamma-camera Tamara-301T using the standard protocol: stage I - angiographic phase, was performed immediately after intravenous bolus administration of 600-800 MBq of 99mTc-methylene diphosphonate; stage II - early static phase, performed in a static mode immediately after the completion of angiographic phase, collection of information for 120 s; stage III - delayed static phase. Results. In deforming osteoarthritis, there was a rapid elimination of the radiological indicator from the pathological focus, in connection with the active washout of the radiopharmaceutical, due to a decrease in the blood supply to the tissues of the region under investigation. In the area of rheumatoid arthritis, on the contrary, there was an increase in the percentage of indicator accumulation in the focus resulting from the intensification of the integral perfusion of these areas, due to increased vascular permeability as a result of the action of the infectious agents, activation of resorption factors and synthesis of mineral components, angiogenesis. Positive, reliable correlations were established between the scintigraphic parameters of radiopharmaceutical incorporation and the number of postoperative implant-associated complications, namely: between scintigraphy indices for rheumatoid arthritis and the number of cases of hematogenous articular infection in the postoperative period - 1 year after arthroplasty (r = 0.581; p < 0.05). Conclusions. The application of the radionuclide model of dual time point imaging facilitates the early detection and reduction of the percentage of paraprosthetic complications in the postoperative period, a decrease in the number of revision arthroplasty and the shortening of rehabilitation after hip and knee arthroplasty.