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The value of intraoperative histology in predicting infection in patients undergoing revision elbow arthroplasty
Shahryar Ahmadi1, Thomas M Lawrence, Bernard F Morrey
1Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for J. Sanchez-Sotelo: sanchezsotelo.joaquin@mayo.edu.
Background:
The perioperative diagnosis of infection in the setting of revision elbow arthroplasty may be difficult to establish. Intraoperative pathology with histology for identification of acute inflammatory changes has been reported to be of value in revision surgery after failed hip or knee arthroplasty. The purpose of this study was to study the role of intraoperative histology in the diagnosis of infection in patients undergoing revision elbow arthroplasty.
Methods:
From 2000 to 2007, 296 consecutive revision elbow procedures were performed at our institution. Both intraoperative histology and operative samples for culture were obtained at the time of 227 of these procedures, which form the basis of this study.
Results:
Histology was read as consistent with acute inflammation in patients undergoing thirty-three procedures (14.5%). Intraoperative cultures were positive in thirty-nine procedures (17.2%). Intraoperative histology was considered true positive (both histology and cultures positive) in twenty arthroplasties (8.8%), true negative (both histology and cultures were negative) in 175 arthroplasties (77.1%), false positive (the histology was positive but the culture was negative) in thirteen arthroplasties (5.7%), and false negative (the histology was negative but the culture was positive) in nineteen arthroplasties (8.4%). With regard to intraoperative histology, the sensitivity was 51.3%, the specificity was 93.1%, and the accuracy was 85.9%. The positive predictive value was 60.6% and the negative predictive value was 90.2%.
Conclusions:
In our study, intraoperative histology had a high specificity and negative predictive value, but a low sensitivity and positive predictive value for predicting infection in the setting of revision elbow arthroplasty. Intraoperative histology should be used in conjunction with other studies to definitively establish the diagnosis of infection in the setting of revision elbow arthroplasty.
Level Of Evidence:
Diagnostic level I. See Instructions for Authors for a complete description of levels of evidence.
Insights
Intraoperative histology aids in diagnosing infection during revision elbow arthroplasty but has low sensitivity. It should complement other diagnostic methods for accurate infection detection in these complex cases.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Diagnosis
- Arthroplasty Research
Background:
- Diagnosing infection during revision elbow arthroplasty presents significant challenges.
- Intraoperative histology is a potential tool for identifying inflammation in revision joint surgeries.
- Previous studies suggest value in hip and knee revision procedures.
Purpose of the Study:
- To evaluate the role and diagnostic accuracy of intraoperative histology.
- To assess its effectiveness in diagnosing infection in revision elbow arthroplasty patients.
Main Methods:
- Retrospective review of 227 revision elbow arthroplasty procedures (2000-2007).
- Collection of intraoperative histology and culture samples.
- Analysis of diagnostic performance metrics: sensitivity, specificity, accuracy, PPV, NPV.
Main Results:
- Histology indicated acute inflammation in 14.5% of cases.
- Intraoperative cultures were positive in 17.2% of cases.
- Histology demonstrated 51.3% sensitivity, 93.1% specificity, and 85.9% accuracy for infection diagnosis.
Conclusions:
- Intraoperative histology shows high specificity and NPV but low sensitivity and PPV for revision elbow arthroplasty infection.
- It is a valuable adjunct but not definitive for diagnosing infection.
- Combine histology with other diagnostic tests for comprehensive assessment.
