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Usefulness of histology for predicting infection at the time of hip and knee revision in patients with rheumatoid arthritis

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

It remains unclear whether rheumatoid arthritis might be a cause of false positive of the histology for the diagnosis of prosthetic joint infection. Our aim was to evaluate the usefulness of the histology for the diagnosis of infection during hip and knee prosthesis revision in patients with rheumatoid arthritis.

Materials and methods

All patients with the diagnosis of rheumatoid arthritis (RA) undergoing hip or knee revision surgery (total or partial) were retrospectively reviewed. Positive histology was considered when ≥ 5 neutrophils per high-power field (400×) were found in at least five separate microscopic fields. Patients who presented ≥ 2 positive cultures for the same microorganism or the presence of fistula were considered as “true positives”.

Results

Thirty-two hip (n = 12) and knee (n = 20) revision procedures were performed. Sensitivity, specificity, positive and negative predictive value of the histology were 50%, 78.6%, 25% and 91.7%, respectively. Six out of the eight patients presenting with positive histology had negative cultures (75.0% of false positives).

Conclusions

Our results suggest that, in the context of RA, negative histological results have a very high negative predictive value. RA poses false positive histology results for the diagnosis of infection during hip and knee revision when conventional cultures are used for diagnosis of infection.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Traumatology, Hospital Clinic, University of Barcelona, Barcelona, Spain

    C. Montoya-delaTorre, J. A. Fernández-Valencia, J. C. Martínez-Pastor & E. Muñoz-Mahamud

  2. Department of Infectious Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain

    L. Morata & A. Soriano

Authors
  1. C. Montoya-delaTorre
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  2. J. A. Fernández-Valencia
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  3. J. C. Martínez-Pastor
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  4. L. Morata
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  5. A. Soriano
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  6. E. Muñoz-Mahamud
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Correspondence to C. Montoya-delaTorre.

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This study was approved by the Ethics Committee of our center under the code HCB/2019/0042 and it does not contain any studies with human participants or animals performed by any of the authors.

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Montoya-delaTorre, C., Fernández-Valencia, J.A., Martínez-Pastor, J.C. et al. Usefulness of histology for predicting infection at the time of hip and knee revision in patients with rheumatoid arthritis. Arch Orthop Trauma Surg 142, 2489–2495 (2022). https://doi.org/10.1007/s00402-021-03868-2

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  • DOI: https://doi.org/10.1007/s00402-021-03868-2

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