The Incidental Hematopoietic Evaluation – Microscopic Examination of Routine Orthopedic Surgical Specimens

Abstract

Routine orthopedic specimens provide a unique opportunity to review the bone marrow of patients. The processing of these specimens differs at different hospitals and has been scrutinized lately due to the recent wave of cost consciousness in health care. We

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

“…Previous studies demonstrate little to no utility of specimen examination after routine primary THA for osteoarthritis. [7][8][9][10][11][12][13] With regard to femoral neck fracture, the current study results are analogous. Historically, intracapsular femoral neck fractures (Orthopaedic Trauma Association 31B) were considered "pathologic" because they often occur through metabolically diseased or osteoporotic bone.…”

“…The average pathology charge per specimen in this study was $195 USD, which is consistent with previous studies. 3,6,8,9 Although this finding may not seem like a large sum, when extrapolating these data to include the 101,800 hip fractures treated with arthroplasty in the United States annually, the potential healthcare savings would be significant. [22][23][24][25] Assuming an average cost of $195USD per FH examination, as in this study, the potential savings would be greater than $19.9 million USD annually.…”

“…5,6 With the current understanding of the pathophysiology of hip fractures in the elderly, one must question the utility and cost-effectiveness of routine PE of FH specimens. Although this scenario has been studied in the setting of elective THA for osteoarthritis, [7][8][9][10][11][12][13] there have been no such studies in the setting of femoral neck fracture. Furthermore, to our knowledge, no literature documents the incidence of positive pathologic findings in FH specimens after femoral neck fractures treated with arthroplasty.…”