SPECT-CT Test May Locate the Source of Unexplained Pain in Hip Implant Patient

Researchers have discovered that the use of single photo emission tomography/CT (SPECT-CT) may help doctors determine the cause of unexplained pain in patients who have undergone metal-on-metal (MoM) hip replacement surgery.

The study involved a review of 15 patients who were a median age of 53, who underwent implantation with 19 different MoM hips devices, and who complained of unexplained pain prior and following SPECT-CT. The researchers compared diagnosis and the management plan for each patient to assess utilization of the SPECT-CT to learn if the SPECT-CT data changed diagnostic outcomes or treatment plans, according to Healio.com. The study is entitled, “Clinical Usefulness of SPECT–CT in Patients with an Unexplained Pain in Metal on Metal (MoM) Total Hip Arthroplasty.”

After comparing the plan and diagnosis for the 19 prosthetic MoM hips in the 15 patients, SPECT-CT was found useful for all 15 patients. Physicians changed the management plan for 13 patients. And, while pain remained unexplained in these 13 cases, the surgeons felt confident in continuing to move forward with non-operative management. The researchers concluded that, SPECT-CT may be of help in surgical management decisions in those MoM hip arthroplasty patients who experience unexplained pain following their procedures.

The team indicated that it found loosening in three femoral stems and one acetabular cup following SPECT-CT; the team recommended revision surgery in all four cases. One patient showed signs of intracapsular joint fluid on the MRI despite a normal SPECT-CT. A local anesthetic hip injection was used to relieve the pain; however, the patient was subsequently advised to undergo revision surgery, according to Healio.com.

MoM devices were found to have a higher failure rate than any other type of hip replacement system, according to a study published in the Lancet. Researchers culled data from the National Joint Registry of England and Wales and studied more than 400,000 devices made by various manufacturers and determined that all-hip metal devices have an overall revision rate of 6 percent within 5 years—not the 1.7 – 2.3 percent seen in plastic or ceramic implants.

Two of the devices included in the study, DePuy’s ASR XL Acetabular System and ASR Hip Resurfacing System, were recalled in 2010 after it was determined that 12 – 13 percent of patients needed revision surgery within 5 years of implantation.

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