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How do frozen and permanent histopathologic diagnoses compare for staged revision after periprosthetic hip
D Alex Stroh1, Aaron J Johnson, Qais Naziri
1Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
Abstract:
Histopathologic analysis of frozen tissue samples is used to aid the intraoperative diagnosis of periprosthetic hip infections, but there are concerns about reliability. The purposes of this study were to determine the rate of concordance between diagnoses of infection made with frozen and permanent sections and to assess how discrepancies affected patient outcomes. A total of 282 samples from 62 patients were collected for frozen and permanent section analysis. There was concordance in 274 samples (97%). In 1 case, discrepancies led to retention of components during persistent infection, and the patient required further revision and antibiotics until infection free. Otherwise, discrepancies did not affect patient outcomes. There is good concordance between frozen and permanent sections for diagnosing periprosthetic hip infection and rarely do these discrepancies affect management.
Insights
Intraoperative frozen sections show high concordance (97%) with permanent sections for diagnosing periprosthetic hip infections. Discrepancies rarely impact patient outcomes, supporting frozen section reliability in surgical decision-making.
Area of Science:
- Orthopedic Surgery
- Pathology
- Infectious Diseases
Background:
- Intraoperative diagnosis of periprosthetic hip infections relies on histopathologic analysis of frozen tissue samples.
- Concerns exist regarding the reliability of frozen sections for accurate diagnosis.
Purpose of the Study:
- To determine the concordance rate between frozen and permanent tissue sections for diagnosing periprosthetic hip infection.
- To assess the impact of diagnostic discrepancies on patient outcomes.
Main Methods:
- Collected 282 tissue samples from 62 patients undergoing surgery for periprosthetic hip infection.
- Performed histopathologic analysis on both frozen and permanent tissue sections.
- Compared diagnoses derived from frozen sections against permanent sections.
Main Results:
- High concordance (97%) was observed between frozen and permanent sections in diagnosing periprosthetic hip infection (274 out of 282 samples).
- A single case of discrepancy led to prolonged treatment but ultimately resolution.
- Discrepancies between the two methods did not significantly affect overall patient outcomes in most cases.
Conclusions:
- Frozen section analysis demonstrates good reliability for intraoperative diagnosis of periprosthetic hip infections.
- The high concordance rate suggests frozen sections are a valuable tool in surgical decision-making for these infections.
- Rare discrepancies between frozen and permanent sections have minimal impact on patient management and outcomes.
