Low sensitivity of histology to predict the presence of microorganisms in suspected aseptic loosening of a joint prosthesis

Abstract

Intraoperative histology has a high specificity and sensitivity when a septic prosthesis loosening is suspected. However, its usefulness to predict the presence of microorganisms when aseptic loosening is suspected is not well defined. Intraoperative histology and cultures from periprosthetic tissue of 61 revision arthroplasties performed owing to suspected aseptic loosening were retrospectively reviewed. Frozen sections were evaluated following Mirra's criteria (adapted by Feldman). Culture was considered positive when the same microorganism was isolated in at least two samples. The cultures were positive in 12 cases and coagulasenegative staphylococci were the most common microorganisms (11 cases). In six out of 12 cases (50%), the histology revealed more than five polymorphonuclear leukocytes per high-power field. The sensitivity, specificity, positive and negative predictive value of histology to detect the presence of microorganisms was 50, 81, 40 and 86%, respectively. In conclusion, intraoperative histology using Mirra's criteria had a low sensitivity to predict the presence of microorganisms in samples from suspected aseptic prosthetic loosening.

Validity of Frozen Sections for Analysis of Periprosthetic Loosening Membranes

“…However, when positive results are obtained, the specificities are 97% and 91%, respectively. Therefore a positive culture renders both methods valuable which also is supported by another study [5]. An underestimated and contributing problem is that aspiration of an adequate sample of fluid from the hip after arthroplasty usually is more difficult to achieve than from a surgically treated knee [18,19].…”

Prosthesis Failure Within 2 Years of Implantation Is Highly Predictive of Infection

“…Therefore, the AAOS clinical practice guidelines [5] may need to be revisited to avoid misclassification of PJI as aseptic loosening. Some authors reported that low-grade PJI often are misclassified as aseptic loosening when obvious clinical signs of infection are missing [2,17]. An accurate diagnosis of the reason of prosthesis failure is important, particularly the differentiation between aseptic loosening and PJI, because the treatment differs profoundly between these two clinical entities.…”

Interface membrane is the best sample for histological study to diagnose prosthetic joint infection

“…5,12,22,23 False-positive results of histology could be because culture and histological specimens are taken from different areas. 5,12,22 Falsenegative results could be attributed to: (1) low virulent microorganisms like Staphylococcus epidermidis 6,7,22,24,25 or Propionibacterium spp 26,27 that do not stimulate neutrophile infiltration, (2) bacteriological contamination of the specimen obtained for culture 12 or (3) the cut-off point (number of neutrophils per field) to establish the diagnosis of infection. 2,4,5,10,13,[28][29][30] Another possibility for inconsistencies in the histological results could be the type of specimen submitted to the laboratory.…”

“…The majority of investigators obtain specimens from pseudocapsule, synovial surface, interface membrane and any tissue area suspected of infection. [6][7][8]12,15,16,22 The objective of our study was to study which is the most accurate specimen for histological diagnosis of prosthetic joint infection.…”

“…Cultures and polymorphonuclear leukocytes count from periprosthetic tissue are the gold standard for the diagnosis of prosthetic joint infections. 2 The specificity and sensitivity of histology has never been 100% [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] and this may be for different reasons. 5,12,22,23 False-positive results of histology could be because culture and histological specimens are taken from different areas.…”