Reliability of intra-operative frozen section study in revision of infected hip arthroplasty

Abstract

Introduction Frozen sections are extensively used to help in the diagnosis of periprosthetic joint infection during revision hip arthroplasty, though there are insufficient data in relation to its usefulness. Methods Twenty-one patients with infected hip arthroplasties were operated in the form of one or two-staged revision hip arthroplasties. A frozen section was obtained intra-operatively and > 5 PMN’s/ HPF was considered as a positive indicator of infection. If the frozen section was reported negative (≤5 PMN’s/HPF), the revision prosthesis was implanted after a thorough debridement and a wash. If the frozen section was reported as positive, post the debridement; a non-articulating antibiotic-loaded cement spacer was implanted for 8 weeks, supplemented with 3 weeks of intravenous antibiotics and 3 weeks of oral antibiotics. This was followed by an antibiotic-free interval of 2 weeks. The patient was taken up for a revision surgery once the frozen section study was negative (≤5 PMN’s/HPF). The patients were followed up for a minimum of 1 year to a maximum of 2 years after the revision for any evidence of infection (assessed clinically, serologically, and radiologically). Results Frozen section analysis of PMNs per high power field had a 100% specificity in our patients in detecting periprosthetic joint infection. Conclusion Frozen section study is a safe, rapid, cheap and reliable intra-operative modality to diagnose periprosthetic joint infection.

Utility of histopathological examination in aseptic revision total hip arthroplasty: a preliminary analysis

“…Particularly, histological analysis is important when the diagnostic work-up is inconclusive, regardless of debates over the ideal threshold of neutrophil number per high-power field. 2,4 While histopathology has been utilised extensively in many studies to diagnose PJI, 2,[5][6][7][8][9][10][11][12][13] little is known about how beneficial it is in aseptic revision arthroplasty procedures. As there are no standards for when to request a histopathological examination during an aseptic revision total hip arthroplasty (THA), the surgeon is still free to choose when to take samples intraoperatively.…”