Clinical Orthopaedics and Related Research®

, Volume 468, Issue 3, pp 762–768

Validity of Frozen Sections for Analysis of Periprosthetic Loosening Membranes

  • Stephan W. Tohtz
  • Michael Müller
  • Lars Morawietz
  • Tobias Winkler
  • Carsten Perka
Clinical Research

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.

Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Athanasou NA, Pandey R, de Steiger R, McLardy Smith P. The role of intraoperative frozen sections in revision total joint arthroplasty. J Bone Joint Surg Am. 1997;79:1433–1434.PubMedGoogle Scholar
  2. 2.
    Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, Osmon DR. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis. 1998;27:1247–1254.CrossRefPubMedGoogle Scholar
  3. 3.
    Bernard L, Lubbeke A, Stern R, Bru JP, Feron JM, Peyramond D, Denormandie P, Arvieux C, Chirouze C, Perronne C, Hoffmeyer P (2004) Groupe D’Etude Sur L’Osteite. Value of preoperative investigations in diagnosing prosthetic joint infection: retrospective cohort study and literature review. Scand J Infect Dis 36:410–416.CrossRefPubMedGoogle Scholar
  4. 4.
    Bernig T, Weigel S, Mukodzi S, Reddemann H. Antibiotic sequential therapy for febrile neutropenia in pediatric patients with malignancy. Pediatr Hematol Oncol. 2000;17:93–98.CrossRefPubMedGoogle Scholar
  5. 5.
    Bori G, Soriano A, García S, Gallart X, Casanova L, Mallofre C, Almela M, Martínez JA, Riba J, Mensa J. Low sensitivity of histology to predict the presence of microorganisms in suspected aseptic loosening of a joint prosthesis. Mod Pathol. 2006;19:874–877.PubMedGoogle Scholar
  6. 6.
    Bori G, Soriano A, García 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;89:1232–1237.CrossRefPubMedGoogle Scholar
  7. 7.
    Bozic KJ, Rubash HE. The painful total hip replacement. Clin Orthop Relat Res. 2004;420:18–25.CrossRefPubMedGoogle Scholar
  8. 8.
    Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999;284:1318–1322.CrossRefPubMedGoogle Scholar
  9. 9.
    Della Valle CJ, Sporer SM, Jacobs JJ, Berger RA, Rosenberg AG, Paprosky WG. Preoperative testing for sepsis before revision total knee arthroplasty. J Arthroplasty. 2007;22(6 suppl 2):90–93.CrossRefPubMedGoogle Scholar
  10. 10.
    Feldman DS, Lonner JH, Desai P, Zuckerman JD. The role of intraoperative frozen sections in revision total joint arthroplasty. J Bone Joint Surg Am. 1995;77:1807–1813.PubMedGoogle Scholar
  11. 11.
    Gallo J, Kolar M, Dendis M, Loveckova Y, Sauer P, Zapletalova J, Koukalova D. Culture and PCR analysis of joint fluid in the diagnosis of prosthetic joint infection. New Microbiol. 2008;31:97–104.PubMedGoogle Scholar
  12. 12.
    Gunthard H, Hany A, Turina M, Wust J. Propionibacterium acnes as a cause of aggressive aortic valve endocarditis and importance of tissue grinding: case report and review. J Clin Microbiol. 1994;32:3043–3045.PubMedGoogle Scholar
  13. 13.
    Ince A, Rupp J, Frommelt 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;39:1599–1603.CrossRefPubMedGoogle Scholar
  14. 14.
    Khan MH, Smith PN, Rao N, Donaldson WF. Serum C-reactive protein levels correlate with clinical response in patients treated with antibiotics for wound infections after spinal surgery. Spine J. 2006;6:311–315.CrossRefPubMedGoogle Scholar
  15. 15.
    Mason JB, Fehring TK, Odum SM, Griffin WL, Nussman DS. The value of white blood cell counts before revision total knee arthroplasty. J Arthroplasty. 2003;18:1038–1043.CrossRefPubMedGoogle Scholar
  16. 16.
    Morawietz L, Classen RA, Schröder JH, Dynybil C, Perka C, Skwara A, Neidel J, Gehrke T, Frommelt L, Hansen T, Otto M, Barden B, Aigner T, Stiehl P, Schubert T, Meyer-Scholten C, König A, Ströbel P, Rader CP, Kirschner S, Lintner F, Rüther W, Bos I, Hendrich C, Kriegsmann J, Krenn V. Proposal for a histopathological consensus classification of the periprosthetic interface membrane. J Clin Pathol. 2006;59:591–597.CrossRefPubMedGoogle Scholar
  17. 17.
    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. 2008;3:31.CrossRefGoogle Scholar
  18. 18.
    Somme D, Ziza JM, Desplaces N, Chicheportiche V, Chazerain P, Leonard P, Lhotellier L, Jacquenod P, Mamoudy P. Contribution of routine joint aspiration to the diagnosis of infection before hip revision surgery. Joint Bone Spine. 2003;70:489–495.CrossRefPubMedGoogle Scholar
  19. 19.
    Spangehl MJ, Masri BA, O’Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am. 1999;81:672–683.PubMedGoogle Scholar
  20. 20.
    Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004;117:556–562.CrossRefPubMedGoogle Scholar
  21. 21.
    Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357:654–663.CrossRefPubMedGoogle Scholar
  22. 22.
    Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645–1654.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Stephan W. Tohtz
    • 1
  • Michael Müller
    • 1
  • Lars Morawietz
    • 2
  • Tobias Winkler
    • 1
  • Carsten Perka
    • 1
  1. 1.Center for Musculoskeletal SurgeryCharité–Universitätsmedizin BerlinBerlinGermany
  2. 2.Institute of PathologyCharité–Universitätsmedizin BerlinBerlinGermany

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