The value of bone SPECT/CT in evaluation of foot and ankle arthrodesis and adjacent joint secondary osteoarthritis.

OBJECTIVE: To evaluate the value of SPECT/CT (single photon emission computed tomography/computed tomography) in foot and ankle arthrodesis and development of secondary osteoarthritis in the adjacent joints. MATERIALS AND METHODS: SPECT/CT of 140 joints in the foot and ankle (34 upper ankle (UA), 28 lower ankle (LA), 27 talonavicular (TN), 12 calcaneo-cuboidal (CC), and 39 other smaller joints after arthrodesis in 72 patients were evaluated retrospectively regarding fusion grade in CT (0 = no fusion, 1 = < 50% fusion, 2 = > 50% fusion, 3 = complete fusion) and radiotracer uptake (0 = no uptake, 1 = mild uptake, 2 = moderate uptake, 3 = high uptake) on SPECT/CT. Severity of osteoarthritis (1 = mild, 2 = moderate, 3 = severe) and radiotracer uptake grade in adjacent joints was also assessed. In 54 patients, clinical information about interventions in the follow-up was available. RESULTS: According to the SPECT/CT, arthrodesis was successful (grade 2 or 3 CT fusion and grade 0 or 1 uptake) in 73% (25/34) of UA joints, 71% (20/28) of LA joints, 67% (18/27) TN, 100% (12/12) CC joints, and 62% (24/39) of other smaller joints. In 12 joints, there were discrepant findings in SPECT/CT (fusion grade 2 and uptake grade 2 or 3 (n = 9); or, fusion grade 0 or 1 and uptake grade 1 (n = 3)). The fusion rate 6-12 months after arthrodesis was 42% (14/33), 59% (20/34) after 13-24 months, and 89% (65/73) after more than 24 months, respectively. Average radiotracer uptake in arthrodesis decreased with age: 6-12 months: 1.60, 12-24 months: 1.32, > 24 months: 0.38. There was a significant negative correlation between radiotracer uptake grade and CT fusion grade. Osteoarthritis was observed in 131 adjacent joints. During the post scan follow-up, additional arthrodeses were performed in 33 joints, of which 11 joints were re-arthrodesis and 22 were new arthrodeses in osteoarthritic adjacent joints. All these 11 joints with failed arthrodesis had grade 0 of CT fusion and grade 2 or 3 of radiotracer uptake. All 22 adjacent joints with osteoarthritis, which subsequently underwent arthrodesis, had grade 2 or 3 radiotracer uptake, and the primary arthrodesis joints were healed and fused in all these cases. CONCLUSION: Bone SPECT/CT is a valuable hybrid imaging tool in the evaluation of foot and ankle arthrodesis and gives additional useful information about the development of secondary osteoarthritis in the adjacent joints with higher value for the assessment of secondary osteoarthritis. A practical four-type classification ('Lucerne Criteria') combining metabolic and morphologic SPECT/CT information for evaluation of arthrodesis joints has been proposed.

Performance Trends in Age Group Triathletes in the Olympic Distance Triathlon at the World Championships 2009-2014.

Performance trends in elite triathletes competing in age group classes have been investigated for Ironman triathlon in 'Ironman Hawaii' but not for short distance triathletes competing at international level in events such as the Olympic distance triathlon at the World Championships. The aim of the present study was to evaluate participation and performance trends of age group triathletes competing in the Olympic distance triathlon at the International Triathlon Union (ITU) World Championships 2009-2014. During this period, the number of participants remained constant. Swimming performance improved in athletes in age groups 25-29 years to 55-59 years, but not in younger (18-24 years) and older (> 60-64 years) age groups. Cycling performance improved in athletes in age groups 18-24 years to 70-74 years, but not in age group 75-79 years. In running, athletes in age groups 18-24 years, 30-34 years, 35-39 years and 65-69 years improved, but not in the other age groups. Overall race time was improved by athletes in age groups 18-24 to 65-69 years, but not in age groups 70-74 years and 75-79 years. Transition times were improved by all age group athletes. Women were slower than men in swimming, cycling, running and overall race time in age groups 18-24 years to 70-74 years, but not in the age group 75-79 years. For transition times, women were slower than men in age groups 18-24 years to 65-69 years, but not in age groups 70-74 years to 75-79 years. In summary, women and men improved performance in most age groups across all years, men were faster than women except in the age group 75-79 years and the sex difference between women and men remained constant. This knowledge should be considered when future age group triathletes train for and compete in Olympic distance triathlons at international level.