Validity of Frozen Sections for Analysis of Periprosthetic Loosening Membranes

Abstract

Clinical findings and blood parameters often are inconclusive in patients with periprosthetic joint infections. Among the accepted criteria for diagnosis, histologic analysis of debrided tissue can detect infection in most cases but does not allow intraoperative decision making. We evaluated the validity of intraoperative frozen sections for detection of prosthetic infections. The results from frozen and permanent sections of periprosthetic membranes of 64 consecutive patients who underwent exchange procedures after hip arthroplasty were compared using the histopathologic consensus classification of Morawietz et al. Blood parameters (erythrocyte sedimentation rate, leukocyte count, C-reactive protein) and culture results of preoperatively aspirated joint fluid and intraoperative tissue samples were correlated with the histologic results. In 50 patients (78.1%), agreement was found between the frozen and permanent sections. Two patients (3.1%) revealed a discrepancy between the two histologic methods. In 12 patients (18.8%), a diagnosis was not possible based on the frozen sections because the tissue samples were not representative enough for definite classification. For the analyzable cases (n = 52), the sensitivity of frozen-section histologic analysis was 86.6%, specificity 100%, and accuracy 96.2%. Our data support a recommendation for use of intraoperative frozen sections for diagnosis of septic versus aseptic loosening in revision hip surgery.

Leukocytosis Is Common After Total Hip and Knee Arthroplasty

“…Our analysis showed the use of postoperative WBC count is only slightly better than random guessing (represented by an AUC = 0.5) in predicting early PJI. Previous literature provides a sensitivity of less than 25% and specificity of greater than 90% for a WBC count greater than 10-11 9 10 6 cells/lL in diagnosing PJI [7,8]. This is in contrast to our findings (sensitivity: 79%; specificity: 46%).…”

High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip

“…The predictive power of the CRP value in our study was less than that reported by other authors [9,46,51]. At a cutoff point of 10 mg/L Schinsky et al [46], Tohtz et al [51], and Buttaro et al [9] regarded the CRP level as an important diagnostic parameter and found a sensitivity between 58% and 94%, specificity between 80% and 91%, PPV between 55% and 61%, NPV between 82% and 96%, and accuracy between 73% and 78%.…”

“…At a cutoff point of 10 mg/L Schinsky et al [46], Tohtz et al [51], and Buttaro et al [9] regarded the CRP level as an important diagnostic parameter and found a sensitivity between 58% and 94%, specificity between 80% and 91%, PPV between 55% and 61%, NPV between 82% and 96%, and accuracy between 73% and 78%. Moreover, the AAOS Work Group pointed out in their guidelines that aspiration or biopsy should be done only if the CRP is increased [1].…”

“…In our study, the sensitivity was 62% and specificity was 100%. Some authors have reported sensitivities and specificities of as much as 100% [4,14,51].…”

“…The hip was considered histologically positive when at least five polymorphonuclear leukocytes per high power field (9400) were identified in one of 10 such fields [37,38,42]. A CRP value greater than 10 mg/L was regarded as positive [9,46,51].…”