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Diagnosis of infection in hip and knee revision surgery: intraoperative frozen section analysis

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Abstract

In this study we validated intraoperatively the analysis of polymorphonuclear leucocyte frozen sections for diagnosis of infection in hip and knee revisions. Between 1996 and 2002 we examined sections and cultured periprosthetic tissues in prosthetic revision in 170 cases, including 146 cases (83 hips and 63 knees). We assessed sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), Youden index, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). We compared intraoperative findings and paraffin-embedded samples. The results in the knee group were SE=66.7%, SP=89.7% [95% confidence interval (CI)], PPV=81% (95% CI), NPV=81.4% (95% CI), Youden index=0.56, PLR=6.5 (95% CI) and NLR=0.4 (95% CI). In the paraffin-embedded samples the results were SE=91%, SP=87% (95% CI), PPV=81% (95% CI), NPV=94% (95% CI), PLR=7 (95% CI) and NLR=8.7 (95% CI). We found a significant difference. The results in the hip group were SE=50%, SP=100% (95% CI), PPV=100% (95% CI), NPV=94.9% (95% CI), Youden index=0.5 and PLR=0.5 (95% CI). In hip and knee prosthetic revision surgery the presence of polymorphonuclear cells correlates with infection, but their absence does not exclude it. It is a quick and inexpensive test that should be included in the diagnostic protocol in revision surgery. Level of evidence: diagnostic Study (investigating a diagnostic test), level I. See instructions to authors for a complete description of levels of evidence.

Résumé

Nous avons analysé des coupes de leucocytes polymorphonucléaires, prélevés per-opératoirement pour le diagnostic des infections de hanche et de genou lors des révisions prothétiques. Entre 1996 et 2002, nous avons examiné les coupes et les cultures des tissus périoprothétiques prélevés lors des révisions de prothèses (170 cas), 146 cas ont été inclus dans cette étude (83 hanches et 63 genoux). Nous avons évalué la sensibilité (SE), la spécificité (SP), la valeur prédictive positive (PPV), la valeur prédictive négative (NPV), l’index de Youden, le ratio positif de probabilité (PLR) et le ratio négatif de probabilité (NLR). Nous avons comparé les prélèvements per-opératoires et les échantillons inclus dans la paraffine. Résultats : Dans le groupe des genoux : SE=66,7%; SP=89,7% (CI 95%); PPV=81% (CI 95%); NPV=81,4% (CI 95%). L’index de Youden=0,56; PLR=6,5 (CI 95%); NLR=0,4 (CI 95%). Paraffine: SE=91%; SP=87% (CI 95%); PPV=81% (CI 95%); NPV=94% (CI 95%); PLR=7 (CI 95%); NLR=8,7 (CI 95%). Nous avons trouvé une différence significative. Dans le groupe de la hanche SE=50%; SP=100% (CI 95%); PPV=100% (CI 95%); NPV=94,9%) (CI 95%); l’index de Youden=0,5; PLR=0,5 (CI 95%). Conclusions: Dans la chirurgie de révision des prothèses de hanches et des prothèses de genoux, la présence de cellules polymorphonucléaires est bien corrélée avec l’infection, mais, son absence n’exclue pas celle-ci. Il s’agit là d’un test rapide, peu invasif qui peut être pratiqué systématiquement dans le protocole de ce diagnostic dans la chirurgie de révision articulaire.

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Authors and Affiliations

  1. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos de Madrid, Madrid, Spain

    Alberto Francés Borrego, Fernando Marco Martínez, Juan Luis Cebrian Parra, David Serfaty Grañeda, Rodrigo García Crespo & Luis López-Durán Stern

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  1. Alberto Francés Borrego
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  2. Fernando Marco Martínez
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  3. Juan Luis Cebrian Parra
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Correspondence to Alberto Francés Borrego.

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Francés Borrego, A., Martínez, F.M., Cebrian Parra, J.L. et al. Diagnosis of infection in hip and knee revision surgery: intraoperative frozen section analysis. International Orthopaedics (SICO 31, 33–37 (2007). https://doi.org/10.1007/s00264-005-0069-4

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  • DOI: https://doi.org/10.1007/s00264-005-0069-4

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