Histopathology in Periprosthetic Joint Infection: When Will the Morphomolecular Diagnosis Be a Reality?

Area of Science:

• Orthopedic surgery
• Pathology
• Infectious disease

Background:

• Septic implant failure diagnosis relies on polymorphonuclear neutrophil (PMN) infiltration in periprosthetic tissues.
• The Musculoskeletal Infection Society uses a histological criterion of >5 neutrophils per high-power field (HPF) in 5 HPFs for diagnosing periprosthetic joint infection (PJI).

Purpose of the Study:

• To review evolving histological techniques and diagnostic cutoffs for PJI.
• To highlight the limitations of current histological criteria for PJI diagnosis.
• To explore the potential of morphomolecular techniques for improved PJI diagnosis.

Main Methods:

• Review of recent literature on histological techniques, sample handling, diagnostic cutoffs, and patient populations in PJI studies.
• Analysis of findings from immunohistochemistry and histochemistry studies.

Main Results:

• The established cutoff of 5 PMNs/HPF may be too high for diagnosing many PJIs.
• Recent studies suggest that current histological methods might underestimate infection prevalence.
• Morphomolecular techniques show promise for more accurate histological diagnosis.

Conclusions:

• Surgeons and pathologists must stay updated on advancements in histological analysis for PJI.
• The diagnostic threshold for PMNs in PJI may require re-evaluation.
• Future research should focus on integrating morphomolecular methods for enhanced PJI histological diagnosis.