I see surgeon Friday. I am facing my third revision and from what I know will be difficult. Here is what bone scan said. I would like to hear opinions on this. I am quite concerned about it. Radionuclide Bone Imaging, Three Phase Examination: Radiopharmaceutical: Tc-99m HDP (technetium-99m-hydroxymethylenediphoshonate) Dose: 21.3 mCi IV push BMI: Not available/78 kg Reason for Consultation: Right knee pain status post multiple replacements the most recent five years previously for evaluation of infection versus loosening. The quality of this examination is acceptable with regards to count density, processed images, data display and lack of important artifacts (including but not limited to motion and attenuation artifacts). Comparison with a prior exam of 10/13/2016 demonstrating evidence of right medial tibial ligament inflammation/enthesopathy with prosthesis loosening of either knee not excluded. Following bolus intravenous administration the radiopharmaceutical agent, perfusion imaging was obtained over the knees in anterior and posterior views with review of dynamic images demonstrating increased perfusion to the right lateral knee. Immediate blood pool imaging obtained in anterior and posterior views demonstrates increasing synovial activity at the right lateral knee and similar focal increase at the medial knee joint. Delayed osseous phase imaging performed 2.5 hours following tracer injection in anterior/posterior and lateral views over the knees demonstrates similar increase of osseous turnover along the tibial aspects of both total knee prostheses and increasing osseous turnover at the lateral femoral condyles bilaterally. IMPRESSION: Abnormal examination. Findings are consistent with resistant loosening of the tibial component of the knee prostheses bilaterally with evidence of collateral ligament inflammation laterally involving both knees.