Intraoperative Synovial C-reactive Protein Is as Useful as Frozen Section to Detect Periprosthetic Hip Infection

Buttaro, Martín; Martorell, Gabriel; Quinteros, Mauricio; Zanotti, Gerardo; Piccaluga, Francisco

doi:10.1007/s11999-015-4340-8

Cited by 33 publications

(14 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A number of novel tests detecting alpha defensin, synovial CRP, and synovial fluid leukocyte esterase among other biomarkers have been successfully described for the diagnosis of PJI [8,9]. These tests have been compared with different reference standards including MSIS criteria [5,27,31,32]. However, none of the studies have specifically evaluated the second stage of revision arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Are Frozen Sections and MSIS Criteria Reliable at the Time of Reimplantation of Two-stage Revision Arthroplasty?

George

Kwiecień

Klika

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Frozen section histology is widely used to aid in the diagnosis of periprosthetic joint infection at the second stage of revision arthroplasty, although there are limited data regarding its utility. Moreover, there is no definitive method to assess control of infection at the time of reimplantation. Because failure of a two-stage revision can have serious consequences, it is important to identify the cases that might fail and defer reimplantation if necessary. Thus, a reliable test providing information about the control of infection and risk of subsequent failure is necessary.Questions/purposes (1) At second-stage reimplantation surgery, what is the diagnostic accuracy of frozen sections as compared with the Musculoskeletal Infection Society (MSIS) as the gold standard? (2) What are the diagnostic accuracy parameters for the MSIS criteria and frozen sections in predicting failure of reimplantation? (3) Do positive MSIS criteria or frozen section at the time of reimplantation increase the risk of subsequent failure? Methods A total of 97 patients undergoing the second stage of revision total hip arthroplasty or total knee arthroplasty in 2013 for a diagnosis of periprosthetic joint infection (PJI) were considered eligible for the study. Of these, 11 had incomplete MSIS criteria and seven lacked 1-year followup, leaving 79 patients (38 knees and 41 hips) available for analysis. At the time of reimplantation, frozen section results were compared with modified MSIS criteria as the gold standard in detecting infection. Subsequently, success or failure of reimplantation was defined by (1) control of infection, as characterized by a healed wound without fistula, drainage, or pain; (2) no subsequent surgical intervention for infection after reimplantation surgery; and (3) no occurrence of PJI-related mortality; and diagnostic parameters in predicting treatment failure were calculated for both the modified MSIS criteria and frozen sections.One author (WB) has received research support in the amount of USD 100,001 to USD 1,000,000 from grants from Stryker (Kalamazoo, Conclusions On the basis of our results, both frozen section and MSIS are recommended at the time of the second stage of revision arthroplasty. Both frozen section and modified MSIS criteria had limited screening capabilities to identify failure, although both demonstrated high specificity. MSIS criteria should be evaluated at the second stage of revision arthroplasty because performing reimplantation in a joint that is positive for infection significantly increases the risk for subsequent failure. Level of Evidence Level III, diagnostic study.MI123 Clin Orthop Relat Res (2016) 474:1619-1626 DOI 10.1007/s11999-015-4673-3 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® Results At the time of second-stage reimplantation sur

show abstract

Section: Discussionmentioning

confidence: 99%

Are Frozen Sections and MSIS Criteria Reliable at the Time of Reimplantation of Two-stage Revision Arthroplasty?

George

Kwiecień

Klika

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…There is no clear guidance on the appropriate number of synovial tissue blocks to use in histological analysis of PJI, and this number ranges from two to five blocks in previous studies [ 19 – 21 ]. Based on methods used at our center, three tissue blocks were submitted for both intraoperative frozen section and postoperative histological paraffin section analysis.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Leukocyte Esterase Testing of Synovial Fluid with Synovial Histology for the Diagnosis of Periprosthetic Joint Infection

et al. 2017

Med Sci Monit

View full text Add to dashboard Cite

BackgroundPeriprosthetic joint infection (PJI) is a complication of total joint arthroplasty (TJA). The leukocyte esterase (LE) strip test and histology are diagnostic methods for PJI. The aims of this study were to determine the sensitivity and specificity of the LE strip test and to compare it with histology in the diagnosis of PJI.Material/MethodsBetween January and December 2015, 93 patients who underwent TJA with PJI were enrolled in the study. Synovial fluid samples were tested with an LE strip, and three synovial tissue samples from each patient underwent frozen section and formalin-fixed histology. Recent criteria from the Musculoskeletal Infection Society (MSIS) were used for the diagnosis of PJI.ResultsNinety-three patients studied included 38 cases of PJI and 55 non-infected cases. Sensitivity and specificity of the LE strip test were 92.1% (95% CI, 77.5–97.9%) and 96.4% (95% CI, 86.4–99.4%), respectively. There was no significant difference in sensitivity (p=0.249) or specificity (p=0.480) between frozen and paraffin sections for histology; the two methods were strongly correlated (ϕ=0.892). Comparison of the LE test results with histology showed a strong correlation (ϕ=0.758, and ϕ=0.840).ConclusionsThe findings of this preliminary study have shown that the LE strip test on synovial fluid showed similar sensitivity and specificity as histology for the diagnosis of PJI, indicating that that further controlled clinical studies should be performed to investigate the role of the LE strip test for the early diagnosis of PJI.

show abstract

“…And secondly -to consider an early implant removal and the use the antibiotic impregnated cement or a spacer and after 6-8 weeks to consider a reimplantation (38). Cemented spacer are most preferably made intraopeatively and are characterized by their fragility and suboptimal dimensions (39,40,41).…”

Section: Periprosthetic Infectionmentioning

confidence: 99%

Perspectives of 3D printing technology in orthopaedic surgery

Zamborský¹,

Kilian²,

Jacko³

et al. 2019

BLL

View full text Add to dashboard Cite

Using most widespread technology of rapid prototyping (RP) in medicine focus on the development of models for diagnosis, for training and planned surgery, as well as the direct manufacture of implants for bone reconstruction. The applications of 3D printing in the fi eld of medicine are giving extraordinary results and tissue and prosthetic 3D printing, medical and engineering research professionals are conducting 3D printing organ bind. Researchers worldwide are pursuing the creation of artifi cial bone using 3D printers, bones that can be later implanted to humans. In near future, many body parts could be manufactured in a turn and successfully implanted to patients. Although medical advances in 3D printing are used in orthopaedic fi eld, research in 4D printing has already started. Flat objects made with 3D printing, using a regular plastic, combined with smart material, were able to become a hub without an external intervention. In nutshell, the future of additive manufacturing (AM) in trauma and orthopedic surgery is relatively bright with the inclusion of 3D printing in medicine. Bioprinting in this area will be focused on fractures, nonunions, deformities and bone, cartilage and soft tissue reconstruction. CONCLUSION: The innovative technology not only assists the medical staff but is also benefi cial for the patients because the medical problems, which were not curable in the past, are now possible with modern technology (Fig. 4, Ref. 52).

show abstract

Intraoperative Synovial C-reactive Protein Is as Useful as Frozen Section to Detect Periprosthetic Hip Infection

Cited by 33 publications

References 19 publications

Are Frozen Sections and MSIS Criteria Reliable at the Time of Reimplantation of Two-stage Revision Arthroplasty?

Are Frozen Sections and MSIS Criteria Reliable at the Time of Reimplantation of Two-stage Revision Arthroplasty?

Comparison of Leukocyte Esterase Testing of Synovial Fluid with Synovial Histology for the Diagnosis of Periprosthetic Joint Infection

Perspectives of 3D printing technology in orthopaedic surgery

Contact Info

Product

Resources

About