The role of SPECT/CT in painful, noninfected knees after knee arthroplasty: a systematic review and meta-analysis-a diagnostic test accuracy review.

PURPOSE: The aim of this systematic review was to present the current evidence on the clinical use of single-photon emission computed tomography/computed tomography (SPECT/CT) in the evaluation of noninfected painful knees after knee arthroplasty. METHODS: Embase, PubMed, Google Scholar, Ovid, Scopus, Science Direct and the Cochrane Database of Systematic Reviews were searched from database inception to May 2022 following the PRISMA guidelines. As a primary outcome, we defined the role of SPECT/CT in the diagnostic approach to noninfected painful knee arthroplasty; as a secondary objective, we described the noninfection-related factors linked to painful knee arthroplasty. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio values and other indicators were calculated; receiver operating characteristic (ROC) curve analysis results and a summary of the areas under the curve (AUCs) from the included studies were reported. A Fagan plot, likelihood ratio plot and Deeks' funnel plot were generated and analysed. Methodological quality was assessed using the QUADAS-2 tool, and the certainty of evidence was assessed by the GRADE approach. RESULTS: A total of 493 publications were identified, of which eight met the inclusion criteria, with a final pooled sample size of 308 patients. The pooled sensitivity and specificity of SPECT/CT in diagnosing the source of pain in painful knee prostheses were 0.86 (95% CI: 0.75-0.93) and 0.90 (95% CI: 0.79-0.96), respectively, with pooled +LR and -LR values of 8.9 (95% CI: 4.11-19.19) and 0.15 (95% CI: 0.09-0.28). The pooled diagnostic odds ratio was 57.35, and the area under the curve was 0.94. SPECT/CT highly accurately identified different sources of pain, such as loosening of the prosthetic components, patellofemoral overloading, instability, malalignment of the components and degeneration of the patellofemoral compartment. The confidence of the estimates was moderate according to the GRADE approach. CONCLUSION: With demonstrated high sensitivity and specificity, as a diagnostic tool, SPECT/CT can identify the source of pain in painful knees after knee arthroplasty, particularly in cases of loosening, patellofemoral disorders and component malalignment (level of evidence III). These findings have significant clinical repercussions, such as in changing the initial diagnosis, identifying or excluding different causes of painful knee arthroplasties, guiding subsequent treatment and positively impacting the final clinical outcome. We moderately recommend the use of SPECT/CT for identifying the source of pain after knee arthroplasty according to the GRADE assessment. This review was preregistered in Prospero under code CRD42022320457.

Cultivo in vitro de condrocitos y reparo de superficies articulares en animales

The objetive of this experimental study is to achieve the production in vitro of inmature cartilaginous cells and its conservation, storing and effectiveness in the repairement of injured articular surfaces. After a broad bibliographic revision of the osteoarticular and chodral allografts as well as the recent studies of culture isolated cells of cartilage, we decited of carry out in a practical way and according to our enviroment along term prospective study of animal comparative experimental chararter with the initial aim to standarized a technique for the obtention of free articular cells as well as to achieve its conservation and obtain its reproduction in vitro using the F-10 HAM medium. After to create articular defaults in the knee of mature rabbits, we graffed with cells previously cultured in the laboratory, we present the preliminar hystologic, morphologic and biochemical results using the mentioned technic. If we obtain good results and an adecuate statistics tests, we will apply the same techinc in human at the label of minor articulations. With the first results we obtained a viability of 80 por cent (with coloration of Trypan-blue), formation of metachromatic reaction (with Toluidin-blue) and a satisfactory result on the 16 week of the allografts; it will be valorated by macroscopic scale of Salter-O'Driscoll; microscopic seale of Shigeyuki and the hystologic rebound criterion of kawabe. In addition we gain the celular crioconservation for more than 120 days using de DMSO 10 por cent as the crioprotector following the schemes and postulates of Schachar and Tomford; avoiding damage of the functions an viability, which was mantain in about 80 por cent