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. Background: A low-grade periprosthetic joint infection (PJI) may present withoutspecific symptoms, and its diagnosis remains a challenge. Three-phase bone scintigraphy (TPBS) and white blood cell (WBC) scintigraphy areincorporated into recently introduced diagnostic criteria for PJI, but their exact value in diagnosing low-grade PJI in patients with nonspecificsymptoms remains unclear.Methods:In this retrospective study, we evaluated patients with a prosthetic jointof the hip or knee who underwent TPBS and/or WBC scintigraphy between 2009 and 2016 because of nonspecific symptoms. We reviewed and calculateddiagnostic accuracy of the TPBS and/or WBC scintigraphy to diagnose orexclude PJI. PJI was defined based on multiple cultures obtained duringrevision surgery. In patients who did not undergo revision surgery, PJI wasruled out by clinical follow-up of at least 2 years absent of clinical signs of infection based on MSIS 2011 criteria.Results:A total of 373 patients were evaluated, including 340 TPBSs and 142 WBC scintigraphies. Thirteen patients (3.5 %) were diagnosed with a PJI. TPBS sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were 71 %, 65 %, 8 % and 98 %, respectively. Thirty-five percent of TPBS showedincreased uptake. Stratification for time intervals between the indexarthroplasty and the onset of symptoms did not alter its diagnosticaccuracy. WBC scintigraphy sensitivity, specificity, PPV and NPV were 30 %, 90 %, 25 % and 94 %, respectively.Conclusion:Nuclear imaging does not have clear added value in patients with low apriori chance of periprosthetic joint infection.

journal of bone and joint infection

Nuclear imaging does not have clear added value in patients with low a priori chance of periprosthetic joint infection. A retrospective single-center experience