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Published on: December 3, 2017
[Histopathologic diagnosis of infectious loosening of joint prostheses]
1Institut für Pathologie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck. bos@patho.uni-luebeck.de
Insights
Quantifying granulocytes and B-cells in tissue reliably diagnoses periprosthetic infection. This method improves accuracy and sensitivity for detecting joint prosthesis infections.
Area of Science:
- Orthopedic surgery
- Infectious disease pathology
Context:
- Periprosthetic infection is a serious complication of joint replacement surgery.
- Accurate diagnosis is crucial for effective treatment and patient outcomes.
- Current diagnostic criteria require optimization for reliability.
Purpose:
- To evaluate the diagnostic reliability of histopathological criteria for periprosthetic infection.
- To quantify inflammatory cells, including lymphocytes and plasma cells, in infected and aseptic joint prostheses.
- To determine the sensitivity, specificity, and predictive values of different cell types as infection markers.
Summary:
- Analysis of 110 tissue specimens from joint prostheses involved quantifying inflammatory cells and immunohistochemically typing lymphocytes and plasma cells.
- Granulocytic infiltration density was the most sensitive marker (91% sensitivity, 84% accuracy).
- B lymphocytes (79% sensitivity, 80% accuracy) and plasma cells (79% sensitivity, 75% accuracy) were predominantly found in infected cases, unlike T lymphocytes seen in aseptic loosening.
Impact:
- Quantification of granulocyte, B-cell, and plasma cell infiltrates offers an important parameter for verifying periprosthetic infection diagnosis.
- This approach enhances the reliability of histopathological assessment in diagnosing joint prosthesis infections.
- Improved diagnostic accuracy can lead to timely and appropriate treatment, potentially reducing morbidity.
Abstract:
To optimize the reliability of histopathological criteria for periprosthetic infection, 110 tissue specimens from joint prostheses were analyzed with quantification of the inflammatory cells and immunohistochemical typing of lymphocytes and plasma cells. As reported in the literature the density of granulocytic infiltration was the most sensitive marker of periprosthetic infection with an accuracy of 84%, a sensitivity of 91%, a specificity of 81%, a positive predictive value of 67%, and a negative predictive value of 95%, using the mostly favored limit value of 5 granulocytes per HPF. T lymphocytes were also found to a high degree in cases of aseptic loosening. In contrast, B lymphocytes were predominantly seen in cases with periprosthetic infection. For B lymphocytes an accuracy of 80% and a sensitivity of 79% were calculated and for plasma cells an accuracy of 75% and a sensitivity of 79%. Our data suggest that the quantification of granulocyte, B-cell, and plasma cell infiltrates is an important parameter for verifying the diagnosis of periprosthetic infection.
