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Histological Analysis of Periprosthetic Tissue for Detecting Prosthetic Joint Infection

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Infected Total Joint Arthroplasty

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Abstract

The possibility of differentiating an aseptic loosening from prosthetic joint infection (PJI) is rather difficult when clinical findings are poor or even absent but is very important since the treatments are different. Unfortunately, to date, there is no preoperative or intraoperative test that is 100 % sensitive and specific for diagnosis of prosthetic infection. Several authors proposed analysis of either frozen or permanent histological sections of periprosthetic tissue as a reliable method for PJI detection. Histological analysis using various criteria for the determination of “positivity” has been touted as a rapid and inexpensive test that has a high specificity; however, its sensitivity has been widely inconsistent ranging from 18 to 100 % in various studies. Histological analysis of periprosthetic tissue at joint revision surgery could be helpful when preoperative tests are ambiguous, but careful attention to the application of criteria for a histological diagnosis must be made to preclude diagnostic errors.

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References

  1. Abdul-Karim FM, McGinis MG, Kraay M, et al. Frozen section biopsy assessment for the presence of polymorphonuclear leukocytes in patients undergoing revision of arthroplasties. Mod Pathol. 1998;11:427–31.

    PubMed  CAS  Google Scholar 

  2. Athanasou NA, Pandey R, de Steiger R, et al. The role of intraoperative frozen sections in revision total joint arthroplasty. J Bone Joint Surg Am. 1997;79:1433–4.

    PubMed  CAS  Google Scholar 

  3. Banit DM, Kaufer H, Harford JM. Intraoperative frozen section analysis in revision total joint arthroplasty. Clin Orthop Relat Res. 2002;400:230–8.

    Article  Google Scholar 

  4. Bori G, Soriano A, Garcia S, et al. Low sensitivity of histology to predict the presence of microorganisms in suspected aseptic loosening of a joint prosthesis. Mod Pathol. 2006;19:874–7. doi:10.1038/modpathol.3800606.

    PubMed  Google Scholar 

  5. Bori G, Soriano A, Garcia S, Mallofre C, Riba J, Mensa J. Usefulness of histological analysis for predicting the presence of microorganisms at the time of reimplantation after hip resection arthroplasty for the treatment of infection. J Bone Joint Surg Am. 2007;89:1232–7. doi:10.2106/JBJS.F.00741.

    Article  PubMed  Google Scholar 

  6. Bori G, Soriano A, Garcia S, Gallart X, Mallofre C, Mensa J. Neutrophils in frozen sections and type of microorganism isolated at the time of resection arthroplasty for the treatment of infection. Arch Orthop Trauma Surg. 2009;129:591–5. doi:10.1007/s00402-008-0679-6.

    Article  PubMed  Google Scholar 

  7. Bori G, Monuz-Mahamud E, Garcia S, et al. Interface membrane is the best sample for histological study to diagnose prosthetic joint infection. Mod Pathol. 2011;24:579–84. doi:10.1038/modpathol.2010.219.

    Article  PubMed  Google Scholar 

  8. Borrego AF, Martinez FM, Parra JLC, Graneda DS, Crespo RG, Stern LLD. Diagnosis of infection in hip and knee revision surgery: intraoperative frozen section analysis. Int Orthop. 2007;31:33–7. doi:10.1007/s00264-005-0069-4.

    Article  Google Scholar 

  9. Charosky CB, Bullough PG, Wilson PD. Total hip replacement failures. A histological ­evaluation. J Bone Joint Surg Am. 1973;55:49–58.

    PubMed  CAS  Google Scholar 

  10. Della Valle CJ, Bogner E, Desai P, et al. Analysis of frozen sections of intraoperative ­specimens obtained at the time of reoperation after hip or knee resection arthroplasty for the treatment of infection. J Bone Joint Surg Am. 1999;81:684–9.

    PubMed  CAS  Google Scholar 

  11. Fehring TK, McAlister Jr JA. Frozen histological section as a guide to sepsis in revision joint arthroplasty. Clin Orthop. 1994;304:229–37.

    PubMed  Google Scholar 

  12. Feldman DS, Lonner JS, Desal P, Zuckerman JD. The role of intraoperative frozen sections in revision total joint arthroplasty. J Bone Joint Surg Am. 1995;77:1807–13.

    PubMed  CAS  Google Scholar 

  13. Ince A, Rupp J, Fromelt L, Katzer A, Gille J, Lohr JF. Is “aseptic” loosening of the prosthetic cup after total hip replacement due to nonculturable bacterial pathogens in patients with low-grade infection? Clin Infect Dis. 2004;39:1599–603.

    Article  PubMed  CAS  Google Scholar 

  14. Lonner JH, Desai P, Dicesare PE, Steiner G, Zuckerman JD. The reliability of analysis of intraoperative frozen sections for identifying acute infection during revision hip or knee arthroplasty. J Bone Joint Surg Am. 1996;78:1553–8.

    PubMed  CAS  Google Scholar 

  15. Mira JM, Amstutz HC, Matos M, et al. The pathology of the joint tissue and its clinical relevance in prosthesis failure. Clin Orthop. 1976;117:221–40.

    Google Scholar 

  16. Moran E, Byren I, Atkins L. Diagnosis and management of prosthetic joint infections. J Antimicrob Chemother. 2010;65 Suppl 3:45–54. doi:10.1093/jac/dkq305.

    Google Scholar 

  17. Morawietz L, Classen RA, Schroder JH, et al. Proposal of histopathological consensus classification of the periprosthetic interface membrane. J Clin Pathol. 2006;59:591–7. doi:10.1136/jcp.2005.027485.

    Article  PubMed  CAS  Google Scholar 

  18. Morawietz L, Tiddens O, Mueller M, et al. Twenty-three neutrophil granulocytes in 10 high-power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening. Histopathology. 2009;847–853. doi:10.1111/j.1365-2559.2009.03313.x.

  19. Müller M, Morawietz L, Hasart O, Strube P, Perka C, Tohtz S. Diagnosis of periprosthetic infection following total hip arthroplasty-evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection. J Orthop Surg Res. 2008;3:31. doi:10.1186/1749-799X-3-31.

    Article  PubMed  Google Scholar 

  20. Nunez LV, Buttaro MA, Morandi A, Pusso R, Piccaluga F. Frozen sections of samples taken intraoperatively for diagnosis of infection in revision hip surgery. Acta Orthop. 2007;78:226–30. doi:10.1080/17453670710013726.

    Article  PubMed  Google Scholar 

  21. Pandey R, Drakoulakis E, Athanasou NA. An assessment of the histological criteria used to diagnose infection in hip revision arthroplasty tissues. J Clin Pathol. 1999;52:118–23.

    Article  PubMed  CAS  Google Scholar 

  22. Pons M, Angels F, Sanchez C, et al. Infected total hip arthroplasty-the value of intraoperative histology. Int Orthop. 1999;23:34–6.

    Article  PubMed  CAS  Google Scholar 

  23. Spangehl MJ, Masri BA, O’Connel JX, et al. Prospective analysis of preoperative and intraoperative investigational for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am. 1999;81:672–83.

    PubMed  CAS  Google Scholar 

  24. Tohtz SW, Muller M, Morawietz L, Winkler T, Parka C. Validity of frozen sections for analysis of periprosthetic loosening membranes. Clin Orthop Relat Res. 2010;468:762–8. doi: 10.107/s! 1999-009-1102-5.

    Article  PubMed  Google Scholar 

  25. Wong YC, Lee QJ, Wai YL, Ng WF. Intraoperative frozen section for detecting active infection in failed hip and knee arthroplasties. J Arthroplasty. 2005;20:1015–20. doi:10.1016/j.arth.2004.08.003.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Faculty of Health Sciences, University of Primorska, Polje 42, Izola, 6310, Slovenia

    Andrej Cör M.D., Ph.D.

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  1. Andrej Cör M.D., Ph.D.
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Correspondence to Andrej Cör M.D., Ph.D. .

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Editors and Affiliations

  1. Orthopedic Hospital Valdoltra, Ankaran, 6280, Koper, Slovenia

    Rihard Trebše

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© 2012 Springer-Verlag London

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Cör, A. (2012). Histological Analysis of Periprosthetic Tissue for Detecting Prosthetic Joint Infection. In: Trebše, R. (eds) Infected Total Joint Arthroplasty. Springer, London. https://doi.org/10.1007/978-1-4471-2482-5_16

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  • DOI: https://doi.org/10.1007/978-1-4471-2482-5_16

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2481-8

  • Online ISBN: 978-1-4471-2482-5

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