Histological and microbiological findings in non-infected and infected revision arthroplasty tissues

Abstract

An assessment of clinical and laboratory findings is generally required to distinguish between septic and aseptic loosening of a hip implant. In order to evaluate the diagnostic utility of histological and microbiological investigative techniques to differentiate between these two conditions, we analysed their results in 617 patients with hip implant loosening. Histology and microbiology study confirmed the clinical diagnosis of septic loosening in approximately 98% and 89%. respectively. The clinical diagnosis of aseptic loosening was confirmed by histology in 99% of cases. In all but 2 of 81 cases of septic loosening, in which an organism was isolated on microbiological culture, the histological diagnosis of septic loosening was made on the basis of the degree of the acute inflammatory infiltrate (i.e. the presence of 1 or more neutrophil polymorphs per high power field (x 400) on average after examination of at least 10 high power fields) in periprosthetic tissues. In 10 patients for whom there was a strong clinical suspicion of septic loosening but no organisms were isolated on microbiological culture, the histological findings, using the above criteria, were in keeping with the clinical diagnosis of septic loosening. As almost 11% of cases of septic loosening would not have been diagnosed by microbiological investigation alone, our findings indicate that histological examination of periprosthetic tissues should form part of the investigative protocol to distinguish between aseptic and septic loosening.

Neutrophil to Lymphocyte Ratio May Be a Diagnostic Marker for Prosthetic Joint Infection

“…One of the problems associated with PJI relates to timely diagnosis of this complication [3,4]. Despite availability of various diagnostic modalities, confirmation of PJI can be difficult in some patients [19][20][21][22]. Further, there is no consensus as to what constitutes a PJI, making its diagnosis very challenging [23].…”

“…Further, there is no consensus as to what constitutes a PJI, making its diagnosis very challenging [23]. Although literature abounds with reports on the accuracy of various tests for diagnosis of PJI [1,4,[20][21][22], the small sample size and the conflicting findings of studies hinder the interpretation of the available data. As screening tools ESR and CRP are excellent and they should be obtained in every patient with a painful TKA.…”

Variation in the Type and Frequency of Postoperative Invasive Staphylococcus aureus Infections According to Type of Surgical Procedure

“…1,[21][22][23][24] Other studies have reported incidences of S. aureus SSI of 0.4-11.6 infections per 100 procedures for cardiothoracic procedures 1,7,[25][26][27] and 0.12-0.73 infections per 100 procedures for orthopedic procedures. [28][29][30][31] The reported incidence of postoperative S. aureus BSI after cardiothoracic procedures is 0.60-1.09 infections per 100 procedures. 1,7 Our results are generally consistent with these procedure-specific rates, although our overall rate of invasive S. aureus infection was lower than that of previously published reports.…”

Septic Loosening of a Total Hip Replacement: Case Report

“…In several studies (11)(12)(13)(14), infection was diagnosed if at least one of the following criteria was present: growth of the same microorganism in two or more cultures of synovial fluid or periprosthetic tissue, purulence of synovial fluid or implant site, acute inflammation on histopathological examination of periprosthetic tissue, or presence of a sinus tract communicating with the prosthesis. Commonly cultured organisms are coagulase-negative staphylococcus (30%-40%), S. aureas (12%-23%), mixed flora (11%), streptococci (9%-10%), gram-negative bacilli (3%-6%), enterococci (3%-7%) and anaerobes (2%-4%) (15,16). No microorganisms are detected in about 11% of apparent infection.…”