Ten Versus Five Polymorphonuclear Leukocytes as Threshold in Frozen Section Tests for Periprosthetic Infection: A Meta-Analysis

Zhao, Xiang; Guo, Chao; Zhao, Gang-Sheng; Lin, Tiantian; Shi, Zhongli; Yan, Shigui

doi:10.1016/j.arth.2012.10.015

Cited by 21 publications

(20 citation statements)

References 31 publications

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“…Setting the threshold for sensitivity and specificity at >0.90, only serum IL-6 met both criteria with a sensitivity of 0.97 and specificity of 0.91. Setting the threshold for both sensitivity and specificity at >0.80, the following additional tests met both criteria: nuclear 18 The lowest reported sensitivities were 0.45 for serum WBC counts [3], 0.64 for tissue histopathology with a threshold of 10 polymorphonuclear (PMN) leucocytes per high-powered field (400×) [50], and 0.72 for bacteriology tests [38]. The lowest reported specificities were 0.70 for erythrocyte sedimentation rate (ESR) [3], followed by 0.73 for nuclear diagnostics using triple-phase bone (TPB) scans and 0.74-0.77 for blood tests using CRP [3,48].…”

Section: Sensitivity and Specificitymentioning

confidence: 99%

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Accuracy of diagnostic tests for prosthetic joint infection: a systematic review

Ahmad

Shaker

Saffarini³

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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Section: Sensitivity and Specificitymentioning

confidence: 99%

“…The highest (worst) LR − values were reported for serum WBC (0.74) [3] and for tissue histopathology with a threshold of ten PMN leucocytes (0.41) per high-powered field (400×) [50].…”

Section: Likelihood Ratiosmentioning

confidence: 99%

Accuracy of diagnostic tests for prosthetic joint infection: a systematic review

Ahmad

Shaker

Saffarini³

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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“…Using the criterion of 5 PMNs per HPF, an independent study by Spangehl et al [20] demonstrated a sensitivity of 80% and a specificity of 94%, while another study, by Wong et al [21], concluded a sensitivity of 93% and a specificity of 77%. On the other hand, 2 recent meta-analyses [7], [22] determined that, compared with 5 PMNs per HPF, 10 PMNs is better for diagnosing PJI. Analysis of variance showed that the specificity was significantly higher in studies using 10 PMNs compared with 5 per HPF ( p = 0.007), while an ROC curve confirmed the trend of superiority for 10 compared with 5 PMNs as the threshold [22].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, 2 recent meta-analyses [7], [22] determined that, compared with 5 PMNs per HPF, 10 PMNs is better for diagnosing PJI. Analysis of variance showed that the specificity was significantly higher in studies using 10 PMNs compared with 5 per HPF ( p = 0.007), while an ROC curve confirmed the trend of superiority for 10 compared with 5 PMNs as the threshold [22]. However, owing to differences in PJI diagnostic criteria and patient characteristics among the studies included in the meta-analyses, the heterogeneity was significant.…”

Section: Discussionmentioning

confidence: 99%

Utility of Intraoperative Frozen Section in the Diagnosis of Periprosthetic Joint Infection

Mao

et al. 2014

PLoS ONE

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PurposeIntraoperative frozen section (FS) is an effective diagnostic test for periprosthetic joint infection (PJI). We evaluated the diagnostic characteristics of single- and multiplex-site intraoperative FS, and evaluated the results of single-site FS combined with those of C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) for assessing PJI.MethodsWe studied 156 painful joint arthroplasties in 152 consecutive patients presenting for revision total joint arthroplasty due to PJI. Receiver operating characteristic analysis was used to determine the optimal cutoff values for CRP level, ESR, and intraoperative FS histopathology. Sensitivity, specificity, positive and negative predictive values, and accuracy of the diagnostic tests were assessed using a 2×2 table.ResultsWe investigated the diagnostic utility of polymorphonuclear leukocyte number (PMN) per high-power field (HPF) on FS. Our data showed that 5 PMNs per HPF is a suitable diagnostic threshold, with a high accuracy in single- and multiplex-site FS. Five PMNs in any 1 of 5 sites had the highest sensitivity of 0.86 and a specificity of 0.96. Five PMNs in every 1 of 5 sites had greater diagnostic utility, with a specificity of 1; however, the sensitivity of this measure fell to 0.62. Five PMNs in single-site FS had a sensitivity of 0.70 and a specificity of 0.94. Five PMNs in single-site FS or CRP level ≥15 mg/L increased the sensitivity to 0.92; however, the specificity decreased to 0.79.ConclusionCompared with single-site FS, any 1 positive site on multiplex-site FS may improve sensitivity, while every 1 positive site on multiplex-site FS may improve specificity. Five PMNs in any 1 of 5 sites on FS has excellent utility for the diagnosis of PJI. Additional systematic large-scale studies are needed to verify this result.

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“…All keywords or MeSH were combined. PJI-related keywords were 196, followed by diagnosis (179), prevention (82), risk factor (74), and outcome (60). All keywords are presented in Supplementary 1.…”

Section: Rankmentioning

confidence: 99%

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

Thies

et al. 2020

Preprint

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Background: Periprosthetic joint infection (PJI) is the most serious complication of joint replacement surgery. Further comorbidities include bedsore, deep vein thrombosis, reinfection, or even death. An increasing number of researchers are focusing on this challenging complication. The aim of the present study was to estimate global PJI research based on bibliometrics from meta-analysis studies. Methods: A database search was performed in PubMed, Scopus, and Web of Science. Relevant studies were assessed using the bibliometric analysis. Results: A total of 117 articles were included. The most relevant literature on PJI was found on Scopus. China made the highest contributions to global research, followed by the United States and the United Kingdom. The institution with the most contributions from the University of Bristol. The journal with the highest number of publications was The Journal of Arthroplasty, whereas the Journal of Clinical Medicine had the shortest acceptance time. The day of the week with the greatest number of received and accepted manuscripts was Wednesday. Furthermore, the top three frequently used databases were Embase, MEDLINE, and Cochrane. The most frequent number of authors in meta-analysis studies was four. Most studies focused on the periprosthetic hip and knee. The alpha-defensin diagnostic test, preventive measures on antibiotics use, and risk factors of intra-articular steroid injections were the most popular topic in recent years. Conclusion: Based on the results of the present study, we found that there was no single database covered all relevant articles, the optimal method for bibliometric analysis is a combination of databases. The most popular research topics on PJI focused on alpha-defensin, antibiotic use, risk factors of intra-articular steroid injections, and the location of prosthetic hip and knee infection. Alpha-defensin appears to be a reliable tool for the diagnosis of PJI.

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Ten Versus Five Polymorphonuclear Leukocytes as Threshold in Frozen Section Tests for Periprosthetic Infection: A Meta-Analysis

Cited by 21 publications

References 31 publications

Accuracy of diagnostic tests for prosthetic joint infection: a systematic review

Accuracy of diagnostic tests for prosthetic joint infection: a systematic review

Utility of Intraoperative Frozen Section in the Diagnosis of Periprosthetic Joint Infection

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

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