The Accuracy of Imaging Techniques in the Assessment of Periprosthetic Hip Infection A Systematic Review and Meta-Analysis

Background: Various imaging techniques are used for excluding or confirming periprosthetic hip infection, but there is no consensus regarding the most accurate technique. The objective of this study was to determine the accuracy of current imaging modalities in diagnosing periprosthetic hip infection. Methods: A systematic review and meta-analysis of the literature was conducted with a comprehensive search of MEDLINE and Embase to identify clinical studies in which periprosthetic hip infection was investigated with different imaging modalities. The sensitivity and specificity of each imaging technique were determined and compared with the results of microbiological and histological analysis, intraoperative findings, and clinical follow-up of > 6 months. Results: A total of 31 studies, published between 1988 and 2014, were included for meta-analysis, representing 1,753 hip prostheses. Quality assessment of the included studies identified low concerns with regard to external validity but more concerns with regard to internal validity including risk of bias (> 50% of studies had insufficient information). No meta-analysis was performed for radiography, ultrasonography, computed tomography, and magnetic resonance imaging because of insufficient available clinical data. The pooled sensitivity and specificity were 88% (95% confidence interval [CI], 81% to 94%) and 92% (95% CI, 88% to 96%), respectively, for leukocyte scintigraphy; 86% (95% CI, 80% to 90%) and 93% (95% CI, 90% to 95%) for fluorodeoxyglucose positron emission tomography (FDG PET); 69% (95% CI, 58% to 79%) and 96% (95% CI, 93% to 98%) for combined leukocyte and bone marrow scintigraphy; 84% (95% CI, 70% to 93%) and 75% (95% CI, 66% to 82%) for antigranulocyte scintigraphy; and 80% (95% CI, 72% to 86%) and 69% (95% CI, 64% to 73%) for bone scintigraphy. Conclusions: Of the currently used imaging techniques, leukocyte scintigraphy has satisfactory accuracy in confirming or excluding periprosthetic hip infection. Although not significantly different, combined leukocyte and bone marrow scintigraphy was the most specific imaging technique. FDG PET has an appropriate accuracy in confirming or excluding periprosthetic hip infection, but may not yet be the preferred imaging modality because of limited availability and relatively higher cost.