Intraoperative evaluation of polymorphonuclear leukocyte during second-stage revision surgery promote overdiagnosis...

Area of Science:

• Orthopedic surgery
• Infectious disease pathology
• Histopathology

Background:

• Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
• Accurate diagnosis and risk stratification are crucial for successful PJI management.
• Intraoperative histopathological examination is a potential tool for assessing infection status.

Purpose of the Study:

• To evaluate the predictive value of intraoperative histopathological examination for infection relapse in patients undergoing revision surgery for PJI.
• To assess the correlation between polymorphonuclear leukocytes (PMNs) in periprosthetic tissues and PJI recurrence.

Main Methods:

• A cohort of 25 patients undergoing two-staged revision for PJI were included.
• Intraoperative histopathological examination of periprosthetic tissue was performed, categorizing samples as PMNs-positive (≥5 PMNs/high-powered field) or PMNs-negative (<5 PMNs).
• Patients were followed for a median of 51 months to assess for infection relapse.

Main Results:

• Intraoperative PMNs positivity was found in 8.0% of cases, while postoperative examination showed 28.0% positivity, with significant discrepancies.
• Poor reproducibility was indicated by the intraclass correlation coefficient.
• Two cases (8.0%) experienced infection relapse, both originating from the PMNs-negative group; no statistical relationship was found between PMNs presence and relapse.

Conclusions:

• Intraoperative histopathological examination is not a reliable predictor of infection relapse in PJI.
• The findings suggest that intraoperative examination may lead to overdiagnosis, potentially resulting in unnecessary antibiotic-impregnated cement use and extended treatment durations.