An assessment of the histological criteria used to diagnose infection in hip revision arthroplasty tissues.

Abstract

Aim-To characterise the number and nature of the inflammatory cells seen in cases of septic or aseptic loosening of hip arthroplasty, and to establish reliable histological criteria to distinguish between these two conditions. Methods-Histological examination of paraYn sections of periprosthetic tissues (pseudocapsule, femoral and acetabular pseudomembranes) of 523 cases of aseptic loosening and 79 cases of microbiology culture proven septic loosening. The cellular composition of the inflammatory cell infiltrate was determined semiquantitatively. Results-The finding of a 2+ or greater neutrophil polymorph infiltrate (one or more cells per high power field (×400) on average after examination of 10 fields) in arthroplasty tissues correlated strongly with the microbiological diagnosis of septic loosening: diagnostic sensitivity 100%, specificity 97%, accuracy 99%, positive predictive value 92%, negative predictive value 100%. The finding of a 3+ neutrophil polymorph infiltrate (five or more cells on average per high power field) had a diagnostic sensitivity of 72%, specificity 100%, accuracy 98%, positive predictive value 100%, and negative predictive value 97%. In some cases of septic loosening the finding of a heavy lymphocytic and plasma cell infiltrate was of low diagnostic sensitivity. A neutrophil polymorph infiltrate (generally less than one cell per 10 high power fields) was also seen in cases of aseptic loosening. Conclusions-The presence of 2+ or more (more than one neutrophil polymorph per high power field (×400) on average after examination of at least 10 high power fields) in periprosthetic tissues provides the most sensitive and accurate histopathological criterion for distinguishing between septic and aseptic loosening of hip arthroplasty. (J Clin Pathol 1999;52:118-123)

Inflammatory response in 85 patients with loosened hip prostheses: A prospective study comparing inflammatory markers in patients with aseptic and septic prosthetic loosening

“…We conclude that histopathological analysis of PMN infiltration in periprosthetic tissue is the best method to distinguish between aseptic and septic loosening of hip prostheses. The usefulness of PMN infiltration is supported by the work of Pandey et al (1999) and Musso et al (2003). The latter authors recommended histology for all suspected cases of total joint infections.…”

High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip

“…Cultures were discontinued and considered negative if no growth was reported after 14 days according to previous studies [24,45,49]. Cultivation of tissue samples was performed essentially as previously described [4,24,42,49,52]. Media were checked daily for bacterial growth.…”

Should Gram Stains Have a Role in Diagnosing Hip Arthroplasty Infections?

“…Although the Gram stain has been commonly used to help diagnose periprosthetic infections associated with total hip arthroplasty, various authors have observed the sensitivity of the test is extremely low, with only a single report of a sensitivity greater than 20% [1,2,8,13,17,21]. Recent reports of the effectiveness of Gram staining in diagnosing periprosthetic infection continue to report low sensitivities, and suggest this test does little to aid the surgeon in making a definitive infection diagnosis [2,8,9,23].…”