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Prosthesis Infection: Diagnosis after Total Joint Arthroplasty with Antigranulocyte Scintigraphy with ^99mTc-labeled Monoclonal Antibodies—A Meta-Analysis¹

¹ From the Clinical Trials and Evidence-Based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, Ioannina, 45110, Greece (E.E.P., T.A.T., J.P.A.I.); Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts–New England Medical Center, Boston, Mass (T.A.T., J.P.A.I.); and Department of Nuclear Medicine, University Hospital of Ioannina, School of Medicine, Ioannina, Greece (A.D.F.). Received December 10, 2005; revision requested January 24, 2006; revision received February 2; accepted March 3; final version accepted April 12. Address correspondence to J.P.A.I. (e-mail: jioannid{at}cc.uoi.gr).

Purpose: To perform a meta-analysis of diagnostic studies regarding the accuracy of antigranulocyte scintigraphy (AGS) with monoclonal antibodies in the identification of prosthesis infection after total hip or knee arthroplasty.

Materials and Methods: PubMed and EMBASE searches were conducted for the identification of relevant studies. Data on the diagnostic performance of AGS with monoclonal antibodies were combined quantitatively across eligible studies, and the overall sensitivity and specificity, along with summary receiver operating characteristic (ROC) curves and likelihood ratios (LRs), were estimated. The above parameters were evaluated for all patients and for various subgroups among the eligible studies. The reference standard used in the individual studies was accepted.

Results: Thirteen eligible studies on nonoverlapping patient groups were included in the meta-analysis; there was a total sample size of 522 implants. The independent random effects summary estimates of sensitivity and specificity were 83% and 80%, respectively. The summary ROC curve estimate for weighted analysis was a sensitivity of 90% for a specificity of 80%. LR syntheses gave a weighted positive LR of 3.99 (95% confidence interval [CI]: 3.13, 5.09) and a weighted negative LR of 0.22 (95% CI: 0.15, 0.34); there was no statistically significant between-study heterogeneity for either metric. Various subgroup analyses did not reveal any statistically significant differences.

Conclusion: AGS with monoclonal antibodies had a reasonably high discriminating ability to identify prosthesis infection in patients who underwent total joint arthroplasty.

© RSNA, 2006