Role of Bone Scintigraphy and X-Ray Imaging in Patients with Avascular Necrosis of the Femoral Head in Hip Arthroplasty

P. Korol, M.N. Tkachenko, V.K. Bondar

Abstract


Introduction. Recently years, the relevance of the problem of avascular necrosis of the knee increased significantly, due to the following factors: an increase in the frequency of the disease; predominant involvement of young people (20–50 years); the progressive course of the disease with subsequent disability; bilateral common localization of the pathological process (31–74 %); complexity and low efficiency of surgical treatment. Objective. Comparative characteristics of the X-ray method and bone scintigraphy in the early diagnosis of avascular necrosis at knee arthroplasty. Materials and methods. Bone scintigraphy was performed on the tomographic scintillation planar gamma camera «Tamara-301 T» after intravenous injection of Tc-99m-pyrophosphate activity of 550–770 MBq. X-ray examination was carried out on the digital X-ray diagnostic complex RDK SCM «Medapparatura QUO». Results. Using the method of X-ray and bone scan 60 patients with osteonecrosis of the knee joint were examined, which were planned for arthroplasty (32 women and 28 men). The age of the patients was from 17 to 45 years old (mean age 31.7 ± 4.2; median 49 years old). Comparison analysis of these methods showed that X-ray diffraction method allowed obtain only qualitative characteristic changes in the joint affected by avascular necrosis (subchondral necrosis condyles, incongruence of articular surfaces, as well as thickening of the cortical layer). When bone scintigraphy allowed obtain qualitative indicators of radiopharmaceutical accumulation in the area of necrosis that can reliably determine the degree of avascular necrosis of the knee at the early stages of the disease process. The greater is the area of low fixation of radiopharmaceutical in the affected components by osteoarthritis of the knee, the significantly higher is a level of their injury pathological process (p < 0.05). Conclusion. Bone scintigraphy and X-rays can be used for the diagnostic screening of patients with total knee arthroplasty, used to determine the stage of pathological process with osteonecrosis, as well as to monitor the dynamics of the pathological process after arthroplasty.


Keywords


avascular necrosis; bone scintigraphy; X-ray; knee joints; endoprosthesis

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DOI: https://doi.org/10.22141/1608-1706.3.17.2016.75789

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