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Diagnosis of infection by frozen section during revision arthroplasty
N A Athanasou1, R Pandey, R de Steiger
1Nuffield Orthopaedic Centre, Oxford, England, UK.
Abstract:
We assessed the efficacy of intraoperative frozen-section histology in detecting infection in failed arthroplasties in 106 hips and knees. We found inflammatory changes consistent with infection (an average of one or more neutrophil polymorphs or plasma cells per high-power field in several samples) in 18 cases; there was a significant growth on bacterial culture in 20 cases. Compared with the bacterial cultures, the frozen sections provided two false-negative results and three false-positive results (sensitivity, 90%; specificity, 96%; and accuracy, 95%). The positive predictive value was 88%, the negative value, 98%. These results support the inclusion of intra-operative frozen-section histology in any protocol for revision arthroplasty for loose components.
Insights
Intraoperative frozen-section histology effectively detects infection in failed joint replacements. This method shows high accuracy, supporting its use in revision arthroplasty to identify infections and guide treatment.
Area of Science:
- Orthopedic Surgery
- Pathology
- Infectious Disease
Background:
- Periprosthetic joint infection (PJI) is a significant complication of arthroplasty.
- Accurate diagnosis of PJI is crucial for successful revision arthroplasty.
- Intraoperative assessment methods are needed to guide surgical decisions.
Purpose of the Study:
- To evaluate the diagnostic efficacy of intraoperative frozen-section histology for detecting infection in failed arthroplasties.
- To compare frozen-section histology results with bacterial cultures.
Main Methods:
- A study was conducted on 106 hips and knees with failed arthroplasties.
- Intraoperative frozen-section histology was performed on surgical specimens.
- Histological findings were compared to intraoperative bacterial cultures.
Main Results:
- Frozen-section histology identified inflammatory changes consistent with infection in 18 cases.
- Bacterial cultures showed significant growth in 20 cases.
- Frozen-section histology demonstrated high sensitivity (90%), specificity (96%), and accuracy (95%) compared to bacterial cultures, with 2 false-negatives and 3 false-positives.
Conclusions:
- Intraoperative frozen-section histology is a reliable method for detecting infection in revision arthroplasty.
- The high accuracy supports its integration into surgical protocols for failed arthroplasties.
- This technique aids in timely diagnosis and appropriate management of periprosthetic joint infections.