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Updated: May 20, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Is It Safe to Implant Prosthesis When Frozen Section Reports Positive During Joint Arthroplasty? A Retrospective
Chiyuan Ma1,2,3,4, Pingan Lin1,2,3,4, Lingyun Wu5
1Department of Orthopedics Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China.
Background:
Periprosthetic joint infection (PJI) remains a devastating complication of joint arthroplasty. Although intraoperative frozen section histology (> 5 neutrophils/HPF) is incorporated into the 2018 MSIS diagnostic criteria, its prognostic value for predicting postoperative PJI remains controversial.
Methods:
Primary or revision THA/TKA procedures in our hospital between January 1, 2015 and December 31, 2021 with intraoperative frozen section histologic results were eligible for inclusion. Association between intraoperative frozen section histology and postoperative PJI was investigated based on the medical records, and a similar analysis of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) was also performed.
Results:
A total of 14,969 knee/hip procedures were identified. After case selection, 797 cases comprising 529 (66.4%) primary and 268 (33.6%) revision were included. According to our data, frozen section positivity showed no PJI association, both in primary (OR, 1.206 [95% CI, 0.133-10.914], P > 0.999) and revision procedures (OR, 1.287 [95% CI, 0.331-5.007], p = 0.717). Conversely, elevated CRP (OR, 15.196 [95% CI, 1.916-120.523], p = 0.001) and ESR (OR, 5.794 [95% CI, 1.4979-22.4129], p = 0.008) predicted PJI exclusively in revisions.
Conclusions:
Therefore, isolated positive frozen section results should not be the sole basis for surgical strategy. Elevated CRP/ESR levels during revision surgery warrant heightened vigilance and consideration of extended anti-infective treatment.
Level Of Evidence:
III.
Insights
Intraoperative frozen section histology is not a reliable predictor of periprosthetic joint infection (PJI). Elevated CRP and ESR levels in revision surgeries, however, may indicate PJI and warrant further investigation.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Histopathology
Background:
- Periprosthetic joint infection (PJI) is a significant complication following joint arthroplasty.
- The 2018 MSIS diagnostic criteria include intraoperative frozen section histology (≥5 neutrophils/HPF) for PJI diagnosis.
- The prognostic value of frozen section histology for predicting postoperative PJI is debated.
Purpose of the Study:
- To evaluate the prognostic value of intraoperative frozen section histology in predicting postoperative PJI.
- To assess the association of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) with PJI in primary and revision arthroplasty.
Main Methods:
- Retrospective analysis of primary or revision total hip/knee arthroplasty (THA/TKA) procedures performed between January 1, 2015, and December 31, 2021.
- Inclusion criteria required intraoperative frozen section histologic results.
- Statistical analysis investigated the association between frozen section results, CRP, ESR, and postoperative PJI.
Main Results:
- A total of 797 cases (529 primary, 268 revision) were analyzed.
- Frozen section positivity did not show a significant association with PJI in either primary (OR, 1.206) or revision (OR, 1.287) procedures.
- Elevated CRP (OR, 15.196) and ESR (OR, 5.794) levels were significant predictors of PJI exclusively in revision surgeries.
Conclusions:
- Isolated positive frozen section results should not solely dictate surgical strategy for PJI.
- Elevated CRP and ESR levels in revision arthroplasty patients necessitate increased vigilance.
- Consideration of extended anti-infective treatment may be warranted in revision cases with elevated inflammatory markers.