Infected total hip arthroplasty - the value of intraoperative histology

Tey, Marc; Angles, Francesc; Sánchez, Carlos; Matamala, Alfredo; Cuchí, Eva; Salavert, Miguel; Forcada, Pilar; Ferrer, H.

doi:10.1007/s002640050299

Cited by 32 publications

(16 citation statements)

References 21 publications

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“…1, 4 The present study and the more recently published articles 8,[10][11][12] that used as gold standard of infection the presence of microorganisms in periprosthetic tissue coincide about the lower values of sensitivity ( Table 3). The problem is the pathogenic significance of intraoperative cultures in the absence of clinical symptoms and inflammatory signs in periprosthetic tissue.…”

Section: Discussionmentioning

confidence: 91%

Low sensitivity of histology to predict the presence of microorganisms in suspected aseptic loosening of a joint prosthesis

et al. 2006

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Intraoperative histology has a high specificity and sensitivity when a septic prosthesis loosening is suspected. However, its usefulness to predict the presence of microorganisms when aseptic loosening is suspected is not well defined. Intraoperative histology and cultures from periprosthetic tissue of 61 revision arthroplasties performed owing to suspected aseptic loosening were retrospectively reviewed. Frozen sections were evaluated following Mirra's criteria (adapted by Feldman). Culture was considered positive when the same microorganism was isolated in at least two samples. The cultures were positive in 12 cases and coagulasenegative staphylococci were the most common microorganisms (11 cases). In six out of 12 cases (50%), the histology revealed more than five polymorphonuclear leukocytes per high-power field. The sensitivity, specificity, positive and negative predictive value of histology to detect the presence of microorganisms was 50, 81, 40 and 86%, respectively. In conclusion, intraoperative histology using Mirra's criteria had a low sensitivity to predict the presence of microorganisms in samples from suspected aseptic prosthetic loosening.

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Section: Discussionmentioning

confidence: 91%

Low sensitivity of histology to predict the presence of microorganisms in suspected aseptic loosening of a joint prosthesis

et al. 2006

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“…4 Reviewing the literature (Table 4), there is a lot of variability in the specimen submitted for histological evaluation. Some investigators did not obtain interface membrane 5,18,33,34 and others did not define the type of specimen analyzed. 10,13,21 It is generally accepted that there is no important differences between tissue specimens.…”

Section: Discussionmentioning

confidence: 99%

“…Cultures and polymorphonuclear leukocytes count from periprosthetic tissue are the gold standard for the diagnosis of prosthetic joint infections. 2 The specificity and sensitivity of histology has never been 100% [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] and this may be for different reasons. 5,12,22,23 False-positive results of histology could be because culture and histological specimens are taken from different areas.…”

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confidence: 99%

Interface membrane is the best sample for histological study to diagnose prosthetic joint infection

et al. 2011

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. Specimens from pseudocapsule and from interface membrane were obtained from each patient. The histology was considered positive for infection when Z5 neutrophils per high-power field ( Â 40) were found. Definitive diagnosis of infection was considered when Z2 cultures were positive for the same microorganism. According to the definition of infection, patients were classified in two groups: (A) patients with aseptic loosening in whom cultures obtained during surgery were negative and (B) patients with prosthetic joint infection. A total of 69 revisions were included in the study; 57 were classified in group A and 12 in group B. In group B, the percentage of positive interface membrane histology was significantly higher than the percentage of positive pseudocapsule histology (83 vs 42%, P ¼ 0.04, Fisher's exact test). The results suggest that periprosthetic interface membrane is the best specimen for the histological diagnosis of prosthetic joint infection.

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“…Labeled leukocyte imaging studies, including both Technetium-99 (Tc-99) [ 26 , 72 , 75 , 78 ] and Indium-111 (In-111) scans [ 26 , 33 , 48 , 64 , 68 ], have demonstrated value in diagnosis of infection; among these studies, In-111 demonstrated more effectiveness as a "rule out" test. Furthermore, several studies examined a combination of Tc-99 bone scans with either Tc-99 [ 65 ] or In-111 white blood cell (WBC) scans [ 33 , 73 , 79 ], which improved the overall diagnostic value. Likewise, labeled leukocyte imaging combined with bone marrow imaging demonstrated effectiveness in diagnosis of PJI [ 34 , 46 , 51 , 75 ].…”

Section: Imagingmentioning

confidence: 99%

Diagnosis of Periprosthetic Joint Infection: An Algorithmic Approach to Patients

Cooper

Valle

2013

Periprosthetic Joint Infection of the Hip and Knee

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Infected total hip arthroplasty - the value of intraoperative histology

Abstract: Intraoperative histology showed a sensitivity of 100% and a specificity of 98%. These results were better than those observed for the other tests evaluated. Our data provide evidence that intraoperative histology is useful tool in the diagnosis of infected total hip arthroplasty.

Cited by 32 publications

References 21 publications

Low sensitivity of histology to predict the presence of microorganisms in suspected aseptic loosening of a joint prosthesis

Low sensitivity of histology to predict the presence of microorganisms in suspected aseptic loosening of a joint prosthesis

Interface membrane is the best sample for histological study to diagnose prosthetic joint infection

Diagnosis of Periprosthetic Joint Infection: An Algorithmic Approach to Patients

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