Histological Analysis of Periprosthetic Tissue for Detecting Prosthetic Joint Infection
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.
KeywordsDiagnosis Histology Frozen sections Sampling
- 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.PubMedCrossRefGoogle 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
- 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.PubMedCrossRefGoogle Scholar