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Published on: December 3, 2017
Meta-analysis of unexpected findings in routine histopathology during total joint replacement
Guy Rubin1, Semion Krasnyansky, Israel Gavish
1Department of Orthopedics, HaEmek Medical Center, Afula, Israel. guy_ru@clalit.org.il
Background:
Routine histopathological analysis of bone extracted during total joint replacement is controversial.
Objectives:
To evaluate the utility of routine histopathological analysis in total joint replacement.
Methods:
We calculated the risk for discrepant diagnosis between the pre- and postoperative histopathological results by performing a meta-analysis of 11 studies (including our data). We also calculated the risk for significant discrepancies.
Results:
The discrepant diagnoses analysis showed a random effect of 3% discrepancies (95% confidence interval 1.2-3.7%). Funnel plot indicates a publication bias; consequently, the conclusions from this analysis should be interpreted with caution. Regarding the significant discrepancy in diagnosis, we performed a meta-analysis of nine studies. Fixed-effects analysis of all the studies resulted in 0.16% significant discrepancies (95% CI 0.02-0.30%) with no heterogeneity (Q = 3.93, degrees of freedom = 9, P = 0.14, /2 = 49.2%), and appropriate fixed-effects models.
Conclusions:
We recommend no further routine histological examination, reserving this tool for cases with a controversial primary diagnosis and unexpected findings during the operation.