Approximately 200,000 total hip replacements are performed in the U.S. each year. Although the incidence of acute infection following hip replacement is reduced as certain preventative measures have been adopted, both early and late infections remain as significant sources of morbidity, mortality and substantial expenses. The treatment of infected joint replacements has been estimated to cost between $50,000-60,000 per patient. Establishing the diagnosis of infection is quite difficult, and much of the morbidity and cost encountered is due to the lack of a single test that is highly accurate, and cost effective in the management of patients with painful total hip prosthesis. Current diagnostic tests including routine radiography, laboratory studies, and nuclear medicine procedures, suffer from significant shortcomings including accuracy and cost. It has been shown that [ 18-F] fluorine deoxyglucose (FDG) and Positron Emission Tomography (PET) reveal sites of inflammation with high sensitivity and specificity. In a pilot study conducted at our institution, we have been able to demonstrate that FDG-PET imaging has high accuracy in the setting of painful total hip prosthesis in a relatively small patient population. The main objective of the proposed research study is to determine the efficacy of FDG-PET imaging in the management of a painful total hip prosthesis in a large patient population. We also intend to compare FDG-PET imaging directly to conventional techniques including radio labeled white cell imaging for the diagnosis of hip infection to determine whether FDG-PET imaging is superior to the existing techniques. Furthermore, we will optimize the FDG-PET imaging criteria for diagnosing infection associated with hip prosthesis. We plan to enroll 530 patients over 5 years for the purposes outlined in the application. By implementing the proposed research, we will be able to demonstrate the effectiveness of this technique in the management of patients with painful hip arthroplasty. We believe this promising technology has great potential for the accurate diagnosis of this serious and challenging clinical problem, and may substantially influence the outcome in these patients.
