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Updated: May 7, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Two-stage revision for periprosthetic joint infection after hip and knee arthroplasty
Jennifer Straub1, Kevin Staats1, Klemens Vertesich1
1Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
Aims:
Histology is widely used for diagnosis of persistent infection during reimplantation in two-stage revision hip and knee arthroplasty, although data on its utility remain scarce. Therefore, this study aims to assess the predictive value of permanent sections at reimplantation in relation to reinfection risk, and to compare results of permanent and frozen sections.
Methods:
We retrospectively collected data from 226 patients (90 hips, 136 knees) with periprosthetic joint infection who underwent two-stage revision between August 2011 and September 2021, with a minimum follow-up of one year. Histology was assessed via the SLIM classification. First, we analyzed whether patients with positive permanent sections at reimplantation had higher reinfection rates than patients with negative histology. Further, we compared permanent and frozen section results, and assessed the influence of anatomical regions (knee versus hip), low- versus high-grade infections, as well as first revision versus multiple prior revisions on the histological result at reimplantation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), chi-squared tests, and Kaplan-Meier estimates were calculated.
Results:
Overall, the reinfection rate was 18%. A total of 14 out of 82 patients (17%) with positive permanent sections at reimplantation experienced reinfection, compared to 26 of 144 patients (18%) with negative results (p = 0.996). Neither permanent sections nor fresh frozen sections were significantly associated with reinfection, with a sensitivity of 0.35, specificity of 0.63, PPV of 0.17, NPV of 0.81, and accuracy of 58%. Histology was not significantly associated with reinfection or survival time for any of the analyzed sub-groups. Permanent and frozen section results were in agreement for 91% of cases.
Conclusion:
Permanent and fresh frozen sections at reimplantation in two-stage revision do not serve as a reliable predictor for reinfection.
Insights
Histology using permanent and frozen sections during two-stage revision arthroplasty is not a reliable predictor of reinfection. This study found no significant association between histological findings and subsequent infection risk in hip and knee revisions.
Area of Science:
- Orthopedic Surgery
- Pathology
- Infectious Disease
Background:
- Histology is commonly used to diagnose persistent infection in two-stage revision hip and knee arthroplasty.
- However, limited data exist on the diagnostic utility of permanent sections in this context.
Purpose of the Study:
- To evaluate the predictive value of permanent histology sections at reimplantation for reinfection risk.
- To compare the diagnostic accuracy of permanent sections versus frozen sections.
Main Methods:
- Retrospective analysis of 226 patients undergoing two-stage revision for periprosthetic joint infection.
- Histology assessed using the SLIM classification; analysis of permanent and frozen sections.
- Statistical analysis included sensitivity, specificity, PPV, NPV, chi-squared tests, and Kaplan-Meier estimates.
Main Results:
- The overall reinfection rate was 18%.
- Neither permanent nor frozen sections showed a significant association with reinfection (sensitivity: 0.35, specificity: 0.63, PPV: 0.17, NPV: 0.81).
- Histology results did not significantly impact reinfection or survival time across subgroups.
Conclusions:
- Permanent and fresh frozen sections at reimplantation are not reliable predictors of reinfection in two-stage revision arthroplasty.
- Histological assessment did not correlate with clinical outcomes in this patient cohort.
