Assessing the Value of Routine Pathologic Examination of Resected Femoral Head Specimens After Femoral Neck Fracture

Davis, Jeffery T.; Rohlfing, Geoffrey; Sagouspe, Kenan; Brambila, Maximino

doi:10.5435/jaaos-d-17-00901

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…The first main finding of this study was that all pathological femoral neck fractures were secondary to metastatic disease and represented 3% of patients in the total cohort (9 of 311), or 5% (9 of 195) of those with confirmed histology findings. This is considerably higher than that reported by Davis et al (0.9%) 12 and Ramisetty et al (0.45%). 6 No conclusive reason can be given for this disparity in prevalence without further comparative studies.…”

Section: Discussioncontrasting

confidence: 58%

“…Davis et al in their retrospective review at a level 1 trauma centre in California, United States of America, evaluated 850 consecutive femoral neck fracture patients, and found no unexpected malignancy in any of the 466 (54.8%) specimens which were sent for histological evaluation. 12 Similarly, true prevalence of pathological fractures in this study cannot be deduced as 45.2% of femoral heads were not sent for histological analysis, and hence missed pathological fractures cannot be definitively excluded.…”

Section: Introductionmentioning

confidence: 65%

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Prevalence of pathological neck of femur fractures in patients undergoing arthroplasty at a tertiary referral hospital

et al. 2021

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BACKGROUND: This study aimed to determine the prevalence of pathological neck of femur (NOF) fractures at a tertiary referral hospital through histological examination of specimens in all NOF fracture patients undergoing hip arthroplasty. A secondary aim was to determine whether the current practice of sending all femoral heads for histological evaluation, to avoid missing unsuspected malignancies, is financially warranted. METHODS: A retrospective folder review of patients who underwent arthroplasty for NOF fractures was conducted. Patients with suspected pathological fractures were managed by the divisional Bone Tumour Unit while fragility traumatic fractures were managed by the Arthroplasty Unit. All femoral heads were sent for histological analysis regardless of suspicion of pathological fracture. Quotes from the public and private sector were sought to determine cost implications of sending femoral head specimens for histology. RESULTS: A total of 311 patients were included. Of these, 11 patients (4%) had suspected pathological fractures, with fragility/traumatic fractures being diagnosed in the remaining 300 patients (97%). Histology results were available for 195 patients (63%), including all the patients with suspected pathological fractures. No unexpected malignant histological results were observed, while nine of the suspected pathological fracture group had pathological fractures, confirmed with histology. CONCLUSION: Pathological lesions were identified in 3% of patients undergoing arthroplasty for NOF fractures in our population, which is higher than other reports in the literature. Routine histological screening of femoral heads to exclude pathological fracture might not be necessary and cost effective, as pathological lesions can accurately be identified by clinical and radiographic evaluation. Level of evidence: Level 4 Keywords: femoral head histology, pathological fracture, neck of femur fracture, metastases, hip arthroplasty

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Section: Discussioncontrasting

confidence: 58%

Section: Introductionmentioning

confidence: 65%

Prevalence of pathological neck of femur fractures in patients undergoing arthroplasty at a tertiary referral hospital

et al. 2021

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“…In our study we didn't find any occurrence of neoplasm or osteomyelitis. Davis et al studied 466 femoral head out of which 4 cases had evidence of neoplasm (Multiple Myeloma, Chronic Lymphocytic Leukemia, Adenocarcinoma of Lung) [13] . The ambiguity comparing with our study could be due to the small sample size.…”

Section: Discussionmentioning

confidence: 99%

The need of routine histopathological examination of resected head of femur after hemiarthroplasty: An observational study

Mallik¹,

Maharaj²,

Mohapatra³

et al. 2020

Int. J. Orthop. Sci.

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The neck of femur fracture is one of the commonest fracture amongst the elderly. Hemiarthroplasty is sought as the standard of treatment in these group of patients. Following surgery the resected head of femur is discarded. Though it has become a norm for routine histopathological evaluation of the head in total hip replacement but this is not the same in hemiarthroplasty. We studied 48 femoral head obtained after hemiarthroplasty in fracture neck of femur. Majority of our patients were female 28(58.33%) and the mode of injury in them was fall at home 19(67.85%) with mean waiting time for surgery 13±2.7days (Range 7.6-18.4days). We found degenerative osteoarthritis in form of Chondromalacia in 26(54.16%) patients among which males 15(57.69%) were the predominant variety presenting with a higher stage which was statistically significant in nature (P value= 0.014, χ2 value=5.994, df=1). Avascular necrosis was seen in 11(22.91%) cases. Though we found female (6) to be more affected but it was not statistically significant (P value=0.772, χ2 value=0.084, df=1). We found no cases of neoplasm or infection in our study. The histopathological study of the femur head didn't alter the further treatment plan of the patients. Hence we won't recommend doing a routine tissue study of the resected head in these group of patients without any prior positive history (like neoplasm) which will lead to savings over health expenses.

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“…3,4 However, previous literature has questioned both the clinical relevance of discrepancies between surgeon diagnosis and histopathological diagnosis and raised concerns about variance in the histological evaluation of resected specimens by pathologists. 5,6 Furthermore, published evaluations of the cost-effectiveness of routine histopathologic examination of arthroplasty specimens have not produced a clear consensus on the subject, with studies both refuting [7][8][9][10] and supporting it as a costeffective practice. 4,11 The College of American Pathologists does recommend the histologic examination of all surgical specimens.…”

mentioning

confidence: 99%

Routine Histopathologic Analysis of Hip and Knee Bone Specimens After Total Joint Arthroplasty

Moschetti

Kunkel

Schilling

et al. 2022

J Am Acad Orthop Surg

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Total hip and total knee arthroplasties (THA/TKA) are some of the most common elective surgeries done in the United States. Routine histopathologic analysis of hip and knee bone specimens after total joint arthroplasty commonly occurs to identify unexpected pathologic findings and serves as a quality assurance measure. As the most common indication for THA and TKA is osteoarthritis, the practice of routine histopathologic analysis may not be routinely warranted. There is no clear consensus on the cost-effectiveness of this practice, and the literature has questioned both the clinical relevance of discrepancies between surgeon diagnosis and histopathological diagnosis and raised concerns about variance in the histological evaluation of resected specimens by pathologists. Femoral head analysis in the setting of femoral neck fractures has been previously reported, yet there is no clear overview for this topic in the setting of elective THA. The histopathologic features of bone specimens during routine total joint arthroplasty, the cost-effectiveness, and current recommendations will be reviewed.

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Assessing the Value of Routine Pathologic Examination of Resected Femoral Head Specimens After Femoral Neck Fracture

Cited by 5 publications

References 22 publications

Prevalence of pathological neck of femur fractures in patients undergoing arthroplasty at a tertiary referral hospital

Prevalence of pathological neck of femur fractures in patients undergoing arthroplasty at a tertiary referral hospital

The need of routine histopathological examination of resected head of femur after hemiarthroplasty: An observational study

Routine Histopathologic Analysis of Hip and Knee Bone Specimens After Total Joint Arthroplasty

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