Intraoperative Frozen Section Histology: Matched for Musculoskeletal Infection Society Criteria

Kwiecień, Grzegorz; George, Jaiben; Klika, Alison K.; Zhang, Yaxia; Bauer, Thomas W.; Rueda, Carlos A. Higuera

doi:10.1016/j.arth.2016.06.019

Cited by 38 publications

(24 citation statements)

References 38 publications

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“…Most previous studies have evaluated histological findings in combined series of hip and knee arthroplasties with a view to determining whether intra-operative frozen section histology is useful in the diagnosis of PJI with no breakdown of the results for hip and knee arthroplasties. Kwiecien et al [ 17 ] studied the frozen section histology of 100 knee and 100 hip arthroplasties and found high specificity, PPV, NPV, accuracy and moderate sensitivity for the diagnosis of PJI; this study also noted 97.6% concordance between the histology results on frozen sections and fixed paraffin embedded sections. Borrego et al [ 18 ] similarly studied 83 hips and 63 knees and found good correlation of the NP count with the microbiological results of PJI but noted that the absence of NPs did not exclude the diagnosis of PJI.…”

Section: Discussionsupporting

confidence: 59%

Correlation of histological and microbiological findings in septic and aseptic knee implant failure

Inagaki

Uchihara

Munemoto

et al. 2019

Arch Orthop Trauma Surg

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Introduction The Musculoskeletal Infection Society (MSIS) has defined specific clinical and laboratory criteria for the diagnosis of periprosthetic joint infection (PJI). In this study we assessed the diagnostic utility of MSIS microbiological and histological criteria for PJI in 138 cases of septic and aseptic knee implant failure. Materials and methods Intra-operative samples from 60 cases of knee septic implant failure (SIF) and 78 cases of aseptic implant failure (AIF), defined on the basis of clinical, laboratory and operative findings/surgical management, were analysed microbiologically and histologically. Findings were correlated with the final clinical diagnosis and the specificity, sensitivity, accuracy, positive and negative predictive value of MSIS microbiological and histological criteria for knee PJI were assessed. Results 80% of SIF cases showed culture of the same organism from two or more samples (ie MSIS microbiological criteria for definite PJI); 8.3% grew an organism from one sample, and 11.7% showed no growth from any sample. 23.1% of AIF cases grew an organism from one sample and 76.9% showed no growth from any sample. MSIS histological criteria for PJI identified 96.7% of SIF cases. The sensitivity, specificity, accuracy and positive and negative predictive value of MSIS histological criteria for PJI were 96.7%, 100%, 98.6%, 100% and 97.5%, respectively. MSIS microbiological and histological criteria identified all AIF cases. Conclusions Knee PJI is more often identified by current MSIS histological than microbiological criteria. A significant proportion of SIF cases show either no growth or growth of an organism from only one sample. AIF is identified by both MSIS microbiological and histological criteria. Correlation of clinical, radiological and laboratory findings is required for the diagnosis of knee PJI.

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Section: Discussionsupporting

confidence: 59%

Correlation of histological and microbiological findings in septic and aseptic knee implant failure

Inagaki

Uchihara

Munemoto

et al. 2019

Arch Orthop Trauma Surg

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“…In a recently published study by Kwiecien et al, when frozen section was evaluated using the MSIS criteria as a gold standard, frozen section demonstrated a very high specificity and positive predictive value of 98.8 and 94.1%, respectively. 62 This makes frozen section a useful test for confirming a diagnosis of PJI if there is an index of suspicion that does not quite fit with a diagnosis of PJI. However, it is worth noting that the aforementioned study was performed at a tertiary care center with a high surgical volume and an experienced pathologist, so it is important to make sure that one has the resources available to maximize the utility of frozen section.…”

Section: Intraoperative Frozen Sectionmentioning

confidence: 99%

New Technologies for Diagnosis of Periprosthetic Hip Infection

2018

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Periprosthetic joint infection (PJI) is a devastating mode of failure following total joint arthroplasty, imposing a serious burden on the healthcare system and society at large. Increasing demand for elective arthroplasty, as well as independent predictions demonstrating future rise in the prevalence of PJI, will lead to an increasing financial burden imposed by this dreadful complication. This challenge is further compounded by disturbing trends, such as drug-resistant organisms among others as a cause of PJI. The aim of this review is to provide the latest updates in the diagnosis of PJI, with a view to identifying areas in need of further research.

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“…The a-defensin lateral flow test introduced in Europe demonstrated findings similar to those of intraoperative frozen sections, with a sensitivity of 67% and a specificity of 93% 56 . Intraoperative frozen section histology was further validated in another study with the Musculoskeletal Infection Society (MSIS) criteria as the gold standard, demonstrating sensitivity of 73.7% and specificity of 98.9% 57 . With regard to the use of imaging for diagnosing PJI, leukocyte scintigraphy had higher sensitivity (88%) and lower specificity (92%) compared with combined leukocyte and bone marrow scintigraphy (sensitivity 69%, specificity 96%) 58 .…”

Section: Shoulder and Elbowmentioning

confidence: 99%

What’s New in Musculoskeletal Infection: Update Across Orthopaedic Subspecialties

Chen

Nana²,

Nelson³

et al. 2017

The Journal of Bone and Joint Surgery

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Intraoperative Frozen Section Histology: Matched for Musculoskeletal Infection Society Criteria

Cited by 38 publications

References 38 publications

Correlation of histological and microbiological findings in septic and aseptic knee implant failure

Correlation of histological and microbiological findings in septic and aseptic knee implant failure

New Technologies for Diagnosis of Periprosthetic Hip Infection

What’s New in Musculoskeletal Infection: Update Across Orthopaedic Subspecialties

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