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Published on: December 3, 2017
Frozen histologic section as a guide to sepsis in revision joint arthroplasty
1Charlotte Orthopedic Specialists, P.A., Hip and Knee Center, NC 28204.
Abstract:
The accurate prediction of occult sepsis is very important in evaluating the patient who has a painful prosthetic joint. Unfortunately, there is no single test that is able to consistently differentiate mechanical from septic loosening. Authors have suggested that the presence of acute inflammation on frozen histologic sections correlated well with positive intraoperative cultures. The authors' experience with frozen sections was examined as a guide to the intraoperative determination of occult sepsis in revision joint surgery. One hundred seven consecutive total joint revisions were performed from 1986 to 1989. All patients had a complete histologic analysis of tissue obtained from multiple surgical sites. The relationship between the frozen section, final culture, and complete histologic analysis was evaluated in a comparative fashion. Using a positive culture as the criterion for the presence of occult infection, a statistical analysis comparing frozen sections and the complete histologic analyses were performed. The sensitivity of a frozen section as a diagnostic test to detect occult periprosthetic infection when present was 18.2%. The specificity of a frozen section to correctly identify the absence of infection was 89.5%. The frozen section is a fairly specific, but not a sensitive, screening test for the detection of occult sepsis. Over reliance on this technique in a revision setting should be avoided.
Insights
Frozen sections are a specific but not sensitive test for detecting occult sepsis in prosthetic joints. This screening method should be used cautiously in revision surgery due to its low sensitivity for infection.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Pathology
Background:
- Accurate diagnosis of occult sepsis in painful prosthetic joints is crucial.
- Differentiating mechanical from septic loosening remains challenging.
- Frozen sections showing acute inflammation have been suggested to correlate with positive intraoperative cultures.
Purpose of the Study:
- To evaluate the utility of frozen sections as an intraoperative diagnostic tool for occult sepsis in revision joint surgery.
- To compare the accuracy of frozen sections with final cultures and complete histologic analysis.
Main Methods:
- One hundred seven consecutive total joint revisions were analyzed.
- Histologic analysis of tissue from multiple surgical sites was performed.
- Frozen sections were compared to final cultures and complete histologic analyses, using positive culture as the gold standard for infection.
Main Results:
- Frozen sections demonstrated a sensitivity of 18.2% for detecting occult periprosthetic infection.
- The specificity of frozen sections in identifying the absence of infection was 89.5%.
- Frozen sections are a specific but not sensitive screening test for occult sepsis.
Conclusions:
- Frozen section analysis is a specific, but not a sensitive, screening test for occult sepsis in revision joint surgery.
- Over-reliance on frozen sections alone for diagnosing infection in this setting is not recommended.
- Further diagnostic methods are necessary for accurate intraoperative assessment of prosthetic joint infection.
