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Prosthetic joint replacements in hips and knees: pilot study for the development of a single imaging test in patients with painful prosthetic joint replacements. 18 F-Fluoride PET-CT and conventional radionuclide bone scans
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Adesanya, Oludolapo Olasunkanmi (2021) Prosthetic joint replacements in hips and knees: pilot study for the development of a single imaging test in patients with painful prosthetic joint replacements. 18 F-Fluoride PET-CT and conventional radionuclide bone scans. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b3678241~S15
Abstract
An increasing number of annual joint replacement operations are performed.
Prosthetic infection and aseptic loosening is very important and distinguishing between them allows prompt and accurate treatment but there is no consensus on how best to image these patients.
I also reviewed the role of CT in prosthetic joint imaging with a spectrum of usual pathologic conditions and CT patterns. This showed that CT plays a significant role in detecting and demonstrating complications of joint prosthesis surgery but it may not be sufficient in itself. CT can be combined, in hybrid imaging, such as SPECT-CT and PET-CT.
I assessed the magnitude of the problem with a retrospective study of painful prosthetic joints in UHCW from symptom onset to diagnosis. This demonstrated significant delays in diagnosis and the need for streamlined and reduced imaging tests with some patients undertaking multiple non-imaging and imaging tests.
I performed a systematic review of the role of 18 F-NaF showed that sodium fluoride positron emission tomography (18 F-NaF-PET) is a promising tool with high sensitivity and specificity in the assessment of joint replacements after the ninth post-surgical month. A further study confirmed the practicality of performing dynamic 18 F NaF PET-CT in detecting aseptic loosening of lower limb prostheses but future research trials with larger patient populations are required.
Beam hardening artefacts occur in CT and hybrid imaging of metallic prosthetic joints. A series of physics experiments to evaluate and correct beam hardening artefacts was performed to alleviate the problem. Beam hardening artefacts from prostheses reduce image quality on 18 F PET-CT. The experiments included pre-filtering with Aluminium; dual-energy CT and mathematical algorithms with MATLAB® filtered back projection. The results showed no significant difference in artefact reduction between the different methods. The artefact-reduction techniques introduce other secondary artefacts with subsequent image quality reduction.
Analysis of data from the prospective dynamic 18 F-NaF PET-CT trial showed inconsistent results due to data corruption and dynamic 18 F-NaF data loss but quantitative methods with Time-Activity Curves and trend line assessment of 99m Tc-MDP 3-phase bone scans was more accurate. The trial problems were identified and suggestions were made for a larger study with opt-in methods for patient recruitment and more involved use of allied healthcare staff for patient recruitment.
I designed and obtained funding for a study to use a novel radiopharmaceutical agent -99m Tc-Tilmanocept (Lymphoseek® ) to assess periprosthetic membranes in vivo. Lymphoseek® binds to the mannose receptor on the cell surface of macrophages and multinucleated giant cells which are likely to reflect wear particle aseptic loosening. Further in vitro periprosthetic membranes tests will also be performed using immunochemistry. This study has not yet been performed but it is hoped that a negative Tilmanocept scan would reassuringly make a diagnosis of wear particle induced aseptic loosening unlikely.
Item Type: | Thesis (PhD) | ||||
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Subjects: | R Medicine > RD Surgery | ||||
Library of Congress Subject Headings (LCSH): | Artificial joints, Artificial joints -- Infections, Prosthesis -- Complications, Total hip replacement -- Complications , Total knee replacement -- Complications, Prosthesis | ||||
Official Date: | February 2021 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Hutchinson, Charles E., Williams, Nigel | ||||
Extent: | 232 leaves : illustrations (black and white, colour), charts | ||||
Language: | eng |
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