Table 2.
Diagnostic modalities for infections of tumor prostheses.
| Modalities | Studies | Findings | Comments |
|---|---|---|---|
| Imaging | X-rays | Bone loss and implant loosening | Low sensitivity and specificity |
| Bone scintigraphy Combined use of labeled leukocyte and Tc-99m sulfur colloid |
High activity on labeled leukocyte. Low Activity on Tc 99m-sulfur colloid |
Moderate sensitivity and specificity | |
| Ultrasound | Joint effusion or synovial hypertrophy | Operated-dependent, low specificity | |
| MRI | High signal intensity in T2 sequence | Usually not helpful due to artifacts | |
| Laboratory | Blood workup | Elevated ESR, CRP | Commonly elevated during the first 2 weeks |
| Elevated WBC count | Commonly elevated during the first 2 weeks | ||
| Joint aspiration | Cultures | Sensitivity 70–90%, specificity 67–91% | |
| Histological examination | - | ||
| Nucleic amplification techniques | PCR, NGS | ||
| Implant Sonication | Cultures | - | |
| Nucleic amplification techniques | PCR, NGS | ||
| Tissue biopsy | Cultures | Sensitivity 70–90%, specificity 67–91% | |
| Histological examination | - | ||
| Nucleic amplification techniques | PCR, NGS |
Abbreviations: MRI, Magnetic Resonance Imaging; ESR, erythrocyte sedimentation rate; CRP, C reaction protein; WBC, white blood cell; PCR, polymerase chain reaction; NGS, Next-Generation Sequencing.