3-Phase bone imaging and SPECT in the follow up of patients with allogenic vascularized knee joint transplants

Summary

Vascularized allotransplantation of knee joints under immunosuppression is a novel approach in orthopedic surgery. During the postoperative course immunosuppressive management depends on perfusion and viability of the graft. Aim: Evaluation of different diagnostic tools in regard to their usefulness and reliability to provide information about microvascularity and viability of vascularized knee joint allografts. Methods: Four patients with allogenic knee joint transplants were studied up to 26 months after transplantation with 3-phase bone scans and SPECT. The results were compared with duplex sonography, angiography, and histology. Results: Two cases without complications were characterized by adequate perfusion in duplex sonography, angiography and early bone scans. Late bone scans demonstrated increased bone metabolism of the transplant. Corresponding biopsy revealed viable bone cells. In one case with partial thrombosis and one case with complete thrombosis of the transplant vessels rapidly decreasing or missing perfusion was detected by duplex sonography, angiography, and bloodpool scintigraphy. Late bone scans showed reduced or absent bone metabolism. Biopsy demonstrated necrotic bone tissue. Due to the advantage of a tomographic technique SPECT allowed a more reliable assessment of graft viability as compared to planar imaging. Conclusion: Our findings confirm bone scintigraphy as a valuable diagnostic tool in patients with allogenic vascularized knee joint transplants. In contrast to other diagnostic approaches, scintigraphy provides reliable information on both viability and perfusion of the transplant within a single noninvasive clinical investigation.

Zusammenfassung

Die gefäßgestielte allogene Kniegelenktransplantation stellt eine neue Form des Kniegelenkersatzes in der orthopädischen Chirurgie dar. Postoperativ wird das immunsuppressive Management von der Perfusion und Vitalität des Transplantates entscheidend mitbestimmt. Ziel: Prüfung verschiedener Methoden bezüglich ihrer Eignung, die vaskuläre Situation und Vitalität derartiger Transplantate zu beurteilen. Methode: Bei 4 Patienten mit einem gefäßgestielten allogenen Kniegelenktransplantat wurden bis zu 26 Monate postoperativ 3-Pha-sen-Skelettszintigramme ergänzt durch SPECT mit den Ergebnissen von Angiographie, Duplexsonographie und Histologie verglichen. Ergebnisse: Zwei Patienten mit komplikationslosem Verlauf zeigten in allen Verfahren eine regelrechte Transplantatdurchblutung. Ein erhöhter Knochenstoffwechsel des Transplantates als Hinweis für vitales Knochengewebe wurde mittels Biopsie bestätigt. Dagegen zeigte sich bei Thrombose (n = 1) oder Abstoßung (n = 1) eine verminderte bis fehlende Perfusion im Frühscan, bestätigt durch Duplexsonographie, Angiographie und Biopsie. In diesen Fällen wies ein reduzierter oder fehlender Knochenstoffwechsel auf eine fehlende Vitalität des Transplantates hin, die bioptisch bestätigt wurde. Aufgrund der überlagerungsfreien Darstellung hatte SPECT gegenüber planaren Bildern eine höhere Aussagekraft hinsichtlich der Vitalitätsbeurteilung des Transplantats. Schlussfolgerung: Die 3-Phasen-Skelettszintigraphie kombiniert mit SPECT ist ein empfehlenswertes nicht-invasives Verfahren zur Verlaufskontrolle bei der gefäßgestielten allogenen Kniegelenktransplantation. Im Vergleich zu den alternativen Methoden bietet es die Möglichkeit, Durchblutung und Vitalität des Transplantats in einer einzigen Untersuchung zu beurteilen.

Keywords

Bone scintigraphy - vascularized bone graft - allogenic knee joint transplantation - viability - microcirculation

Schlüsselwörter

Szintigraphie - gefäßgestieltes Knochentransplantat - allogenes Kniegelenkstranplantat - Vitalität - Mikrozirkulation

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