Diagnosis of infection in hip and knee revision surgery: intraoperative frozen section analysis

Abstract

In this study we validated intraoperatively the analysis of polymorphonuclear leucocyte frozen sections for diagnosis of infection in hip and knee revisions. Between 1996 and 2002 we examined sections and cultured periprosthetic tissues in prosthetic revision in 170 cases, including 146 cases (83 hips and 63 knees). We assessed sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), Youden index, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). We compared intraoperative findings and paraffin-embedded samples. The results in the knee group were SE=66.7%, SP=89.7% [95% confidence interval (CI)], PPV=81% (95% CI), NPV=81.4% (95% CI), Youden index=0.56, PLR=6.5 (95% CI) and NLR=0.4 (95% CI). In the paraffinembedded samples the results were SE=91%, SP=87% (95% CI), PPV=81% (95% CI), NPV=94% (95% CI), PLR=7 (95% CI) and NLR=8.7 (95% CI). We found a significant difference. The results in the hip group were SE=50%, SP=100% (95% CI), PPV=100% (95% CI), NPV=94.9% (95% CI), Youden index=0.5 and PLR=0.5 (95% CI). In hip and knee prosthetic revision surgery the presence of polymorphonuclear cells correlates with infection, but their absence does not exclude it. It is a quick and inexpensive test that should be included in the diagnostic protocol in revision surgery. Level of evidence: diagnostic Study (investigating a diagnostic test), level I. See instructions to authors for a complete description of levels of evidence.Résumé Nous avons analysé des coupes de leucocytes polymorphonucléaires, prélevés per-opératoirement pour le diagnostic des infections de hanche et de genou lors des révisions prothétiques. Entre 1996 et 2002, nous avons examiné les coupes et les cultures des tissus périoprothétiques prélevés lors des révisions de prothèses (170 cas), 146 cas ont été inclus dans cette étude (83 hanches et 63 genoux). Nous avons évalué la sensibilité (SE), la spécificité (SP), la valeur prédictive positive (PPV), la valeur prédictive négative (NPV), l'index de Youden, le ratio positif de probabilité (PLR) et le ratio négatif de probabilité (NLR). Nous avons comparé les prélèvements per-opératoires et les échan-tillons inclus dans la paraffine. Résultats : Dans le groupe des genoux : SE=66,7%; SP=89,7% (CI 95%); PPV=81% (CI 95%); NPV=81,4% (CI 95%). L'index de Youden=0,56; PLR=6,5 (CI 95%); NLR=0,4 (CI 95%). Paraffine: SE=91%; SP=87% (CI 95%); PPV=81% (CI 95%); NPV=94% (CI 95%); PLR=7 (CI 95%); NLR=8,7 (CI 95%). Nous avons trouvé une différence significative. Dans le groupe de la hanche SE=50%; SP=100% (CI 95%); PPV=100% (CI 95%); NPV=94,9%) (CI 95%); l'index de Youden=0,5; PLR=0,5 (CI 95%). Conclusions: Dans la chirurgie de révision des prothèses de hanches et des prothèses de genoux, la présence de cellules polymorphonucléaires est bien corrélée avec l'infection, mais, son absence n'exclue pas celle-ci. Il s'agit là d'un test rapide, peu invasif qui peut être pratiqué systém-atiquement dans le protocole de ce diagnostic dans la chirurgie de révision a...

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

“…In this study, there were no significant differences in sensitivity (p=0.249) or specificity (p=0.480) between frozen section and formalin-fixed, paraffin section histology, which is similar to previously published results [ 23 – 25 ]. However, a comparison of three tissue blocks corresponding to each type of histological analysis demonstrated internal inconsistency.…”

Histopathology in Periprosthetic Joint Infection: When Will the Morphomolecular Diagnosis Be a Reality?

“…As with all diagnostic tests, if we raise the histology test's cutoff point for defining infection to ten PMNs, we reduce the sensitivity while increasing the specificity; if we lower it to one PMN, the reverse is the case. The new definition proposed by the MSIS for periprosthetic infection uses five PMNs as cutoff point, because it is the most frequently used worldwide and because several studies have shown that there is no difference between using five or ten PMNs [ 6 , 17 , 22 ]. However, certain microorganisms, especially coagulase-negative staphylococci (CNS) and P. acnes , can cause a periprosthetic infection with a PMN infiltration rate below five [ 11 , 23 , 35 , 42 , 47 ].…”

Diagnosis of prosthetic joint infection by beadmill processing of a periprosthetic specimen

“…Bone and joint infections comprise a diverse set of diseases that share common microbiological diagnostic procedures, and raise identical issues, including resuscitation of non‐replicative bacteria, dissociation of bacteria from biofilm and processing of solid tissues or recovered implanted devices. Prosthetic joint infection (PJI) is the best studied bone and joint infection, with a large set of data available in the literature [1–7].…”