PMC5579881_01
Resumed images of a triple-phase scintigraphy of a 26-year old male with a history bilateral hip dysplasia who underwent a one-stage bilateral sequential cementless total hip arthroplasty two months previously, showing evidence of increased hyperperfusion and bone turnover in the left foot and ankle at the second and third phases, compatible with Sudeck syndrome.
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F1
Bone scintigraphy, done two months postoperatively, showed an increased diffuse bone turnover in the left foot and ankle at the second and third phases (1 and 3 h after the isotope injection, respectively), suggesting a moderately chronic disease (Figure 1).
PMC5579881_02
(A) Anteroposterior and (B) oblique right foot's X-ray of 28-year old male, 15 days after he underwent a total hip replacement due to an advanced Legg-Perthes disease on his right hip, showing minimal osteoporotic changes on the right foot and ankle, especially at the tarsus and metatarsophalangeal joints. (C) Third-phase anteroposterior and (D) lateral bone scan images of both legs and feet of the same patient, displaying increased isotope accumulation along the right foot.
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F2
As shown in Figure 2, radiographs demonstrated minimal osteoporotic changes on the right foot and ankle. Triple-phase bone scintigraphy performed during hospital stay showed hyperperfusion of the right foot on both the vascular and late phases of the right foot (Figure 2) as well as around the acetabular and femoral components, considered as acute reparative changes following THR.
PMC5579881_03
(A) Anteroposterior right hip radiograph of a 25-year old male with sequelae of a traumatic basicervical right hip fracture treated at another institution one year earlier, evidencing signs of non-union. (B) Anteroposterior X-ray view of the same patient after treatment with an antibiotic-impregnated cement spacer, as part of a two-stage protocol revision surgery. (C) Radiographic image of the same hip eight weeks later, following reimplantation with a distally fixed uncemented stem and a cementless acetabular component.
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F3
Given the proximal femoral metaphyseal osseous defect, in the context of bone chronic infection, a two-stage revision THR was planned (Figure 3).
(A) Anteroposterior and (B) lateral radiographs of the patient mentioned on Figure 3 at a one-month period after the performance of the reimplantation, presenting mottled osteoporotic changes all along the distal femur and proximal tibia.
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F4
Radiographs revealed diffuse, stippled osteoporotic changes in the right knee (Figure 4) and foot and ankle.
(A) T2 fat suppressed-coronal image of the right knee of the patient cited before (Figures 3 and 4) revealing diffuse intraosseous oedema, especially in the lateral femoral condyle. (B) T2 sagittal image of the patient's right foot showing disperse bone marrow oedema of both hindfoot bones, tarsal bones and proximal phalanxes. T2 fat suppressed-coronal images of the patient's (C) right hindfoot and (D) midfoot, with marked oedema inside the talus, calcaneus and 2nd and 3rd cuneiform bones.
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F5
Accordingly, magnetic resonance imaging (MRI) of the right lower extremity showed intraosseous oedema in the distal femoral lateral epicondyle, proximal tibial metaphysis, talus, calcaneus, tarsal bones and metatarsophalangeal joints (Figure 5).