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Diagnosis of infection in hip and knee revision surgery: intraoperative frozen section analysis
Alberto Francés Borrego1, Fernando Marco Martínez, Juan Luis Cebrian Parra
1Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos de Madrid, Madrid, Spain. albertofrances@hotmail.com
Unlabelled:
In this study we validated intraoperatively the analysis of polymorphonuclear leucocyte frozen sections for diagnosis of infection in hip and knee revisions. Between 1996 and 2002 we examined sections and cultured periprosthetic tissues in prosthetic revision in 170 cases, including 146 cases (83 hips and 63 knees). We assessed sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), Youden index, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). We compared intraoperative findings and paraffin-embedded samples. The results in the knee group were SE=66.7%, SP=89.7% [95% confidence interval (CI)], PPV=81% (95% CI), NPV=81.4% (95% CI), Youden index=0.56, PLR=6.5 (95% CI) and NLR=0.4 (95% CI). In the paraffin-embedded samples the results were SE=91%, SP=87% (95% CI), PPV=81% (95% CI), NPV=94% (95% CI), PLR=7 (95% CI) and NLR=8.7 (95% CI). We found a significant difference. The results in the hip group were SE=50%, SP=100% (95% CI), PPV=100% (95% CI), NPV=94.9% (95% CI), Youden index=0.5 and PLR=0.5 (95% CI). In hip and knee prosthetic revision surgery the presence of polymorphonuclear cells correlates with infection, but their absence does not exclude it. It is a quick and inexpensive test that should be included in the diagnostic protocol in revision surgery.
Level Of Evidence:
diagnostic Study (investigating a diagnostic test), level I. See instructions to authors for a complete description of levels of evidence.
Insights
Intraoperative frozen section analysis of polymorphonuclear leucocytes aids in diagnosing infection during hip and knee revision surgery. While their presence suggests infection, absence does not rule it out, making it a valuable diagnostic tool.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Diagnosis
- Histopathology
Background:
- Periprosthetic joint infection is a significant complication in hip and knee revision surgeries.
- Accurate and timely diagnosis is crucial for effective treatment and patient outcomes.
- Intraoperative diagnostic methods can guide surgical decisions.
Purpose of the Study:
- To validate the intraoperative analysis of polymorphonuclear leucocyte (PMN) frozen sections for diagnosing infection in hip and knee revision surgeries.
- To compare the diagnostic accuracy of intraoperative frozen sections with traditional paraffin-embedded samples.
Main Methods:
- A diagnostic study (Level I evidence) involving 170 cases of hip and knee prosthetic revision surgery (1996-2002).
- Intraoperative frozen sections and periprosthetic tissue cultures were analyzed.
- Sensitivity, specificity, predictive values, and likelihood ratios were calculated for both methods.
Main Results:
- In knee revisions, intraoperative frozen sections showed SE=66.7%, SP=89.7%, PPV=81%, NPV=81.4%.
- Paraffin-embedded samples in knee revisions demonstrated higher accuracy (SE=91%, SP=87%, PPV=81%, NPV=94%).
- In hip revisions, intraoperative frozen sections had SE=50%, SP=100%, PPV=100%, NPV=94.9%.
Conclusions:
- The presence of polymorphonuclear cells in intraoperative frozen sections correlates with infection in hip and knee revision surgery.
- However, their absence does not exclude infection, necessitating consideration of other diagnostic factors.
- Intraoperative frozen section analysis is a quick, inexpensive test that should be integrated into the diagnostic protocol for revision surgery.
