Nucpaedia
Nucpaedia
Musculoskeletal · ⁹⁹ᵐTc-MDP, ⁹⁹ᵐTc-HMPAO leucocytes, ⁹⁹ᵐTc-colloid · Intermediate

A painful hip replacement

History

72-year-old man with a right total hip replacement 5 years ago, now 6 months of thigh pain, worse on weight-bearing. CRP 18 mg/L. Radiographs show a thin lucent line along part of the femoral stem. Hip aspiration was dry. The orthopaedic surgeon asks: 'Septic or aseptic loosening?'

Step 1 · Three-phase bone scan

Three-phase ⁹⁹ᵐTc-MDP bone scan, anterior views of the pelvis and thighs: flow, blood pool at 5 min and delayed images at 3 h. Arrows mark the areas in question.
Three-phase ⁹⁹ᵐTc-MDP bone scan, anterior views of the pelvis and thighs: flow, blood pool at 5 min and delayed images at 3 h. Arrows mark the areas in question.

What can be concluded from the bone scan?