Is a 3-phase bone scan indicated for chronic displaced patella fracture after total knee replacement (TKR) in the absence of suspected infection?

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From the Research

Indications for 3-Phase Bone Scan

  • A 3-phase bone scan is used to assess patellar vascularity in total knee replacement (TKR) surgeries, particularly after lateral release 1.
  • The scan can help identify patellar hypovascularity, which is associated with lateral retinacular release (LR) and other surgical procedures that can compromise patellar viability 1.

Chronic Displaced Patella Fracture after TKR

  • Patellar fractures after TKR are infrequent, with a prevalence of 0.68% 2.
  • The management of patellar fractures after TKR can be challenging, and treatment is guided by the integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone stock 2.
  • There is no direct evidence to suggest that a 3-phase bone scan is indicated for chronic displaced patella fracture after TKR in the absence of suspected infection.

Usefulness of 3-Phase Bone Scan in Evaluating Pain after TKR

  • A 3-phase bone scan has a limited role in evaluating pain in the knee region after TKR, with a positive predictive value of 2.53% and a negative predictive value of 100% 3.
  • The scan may be useful in situations where abnormal serology is present, but repeated joint aspirations samples are inconclusive 3.

Patellar Fractures after TKR

  • Patellar fractures after TKR can occur, with a diverse range of fracture patterns, including transverse, comminuted, vertical, and avulsion fractures 4.
  • The incidence of patellar fractures after TKR is 1.14%, with a mean time to fracture of 17.5 months 4.
  • Treatment of patellar fractures after TKR is guided by the presence of symptoms, disruption of the extensor mechanism, and the quality of the remaining bone stock 2, 4.

References

Research

Patellar fracture after total knee arthroplasty.

The Journal of bone and joint surgery. American volume, 2002

Research

Three-phase Technetium-99m bone scanning in patients with pain in the knee region after cemented total knee arthroplasty.

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2019

Research

Patellar fractures after total knee replacement.

AJR. American journal of roentgenology, 2005

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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