Prosthetic Loosening

CSC Lead: Dika

This project has been removed to the graveyard. An exploratory data analysis demonstrated that the data for this project is too complex, too varied and too few to proceed at this point in time. This project may be re-visited at a later dat but it is not currently being actively work on.

Bone scan and SPECT CT are effective ways of assessing loosening as the metal artefact reduces the clarity of other imaging modalities. Patients will also be referred to x-ray and CT, but SPECT/CT supersedes these for accuracy.

Rationale:
Prosthetic loosening is definitively diagnosed with a SPECT/CT. Around 40% of cases are not obvious and in 20% of cases the report is changed with further consultation. An AI tool would help in accuracy and increase confidence in reporting.
Patient pathway:
Patients are referred as a result of:

1 – pain in the replacement site
2 – x-ray investigations suggest loosening

Patients are referred from orthopaedics and surgery to consider replacement of a prosthesis or to revise the replacement. Next steps are decided by SPECT/CT reports. SPECT/CT is also used for surveillance so imaging is repeated in intervals.
Training data:
250 patients annually. Data to be gathered retrospectively.
Errors:
When the diagnosis of prosthetic loosening is missed, the patient remains in chronic (severe) pain for a prolonged amount of time. When the diagnosis of prosthetic loosening is incorrect, patient undergoes unnecessary surgery.
Goals:
Reducing patient pain and avoiding unnecessary surgery. Improving diagnosis speed and accuracy. success-criteria: Increased diagnostic accuracy and thus reduction in unnecessary surgery, increase in speed with which loosening is diagnosed.
Alternatives:
Currently no commercial products identified.

Clinical lead: Sanjay Vijayanathan

References