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THA After Acetabular Fracture Fixation: Is Frozen Section Necessary?

  • Symposium: Papers Presented at the Hip Society Meetings 2010
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Infection is uncommon after THA performed for failed acetabular fracture repair, despite a high reported incidence of culture-positive fixation implants. The use of frozen section analysis at the time of THA after acetabular fracture fixation surgery is unknown.

Questions/purposes

We asked whether frozen section analysis predicted occult infection after THA performed after acetabular fracture repair.

Methods

We retrospectively reviewed the charts of 43 of 49 patients with prior acetabular fracture fixation who had intraoperative frozen section and culture data from a conversion THA between 2002 and 2010. The average age of patients at fracture was 53 years; conversion was performed after an average of 553 days (median, 369 days; range, 51–2951 days). Five patients had an infection after acetabular fracture surgery (three deep, two superficial). At conversion we obtained an average of three frozen section specimens per patient; 10 specimens in eight patients contained greater than 10 polymorphonuclear cells/high-power field. The minimum followup was 51 days (median, 256 days; range, 51–2085 days).

Results

Five patients had positive intraoperative cultures, three of whom had a positive frozen section. All patients who had prior deep infection developed positive intraoperative cultures. The sensitivity, specificity, positive predictive value, and negative predictive value of frozen section analysis were 0.60, 0.87, 0.38, and 0.94, respectively.

Conclusion

Infection complicating THA after acetabular fracture repair is uncommon. A history of deep infection complicating the acetabular fracture surgery was the strongest predictor of infection. Frozen section analysis has a high specificity and negative predictive value.

Level of Evidence

Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Dori Kelly and Mary Forte, PhD, DC, for their assistance in the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, S11B, Baltimore, MD, 21201, USA

    Robert S. Sterling MD, Erik M. Krushinski MD & Vincent D. Pellegrini Jr MD

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  1. Robert S. Sterling MD
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  2. Erik M. Krushinski MD
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  3. Vincent D. Pellegrini Jr MD
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Correspondence to Robert S. Sterling MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the University of Maryland School of Medicine, Baltimore, MD, USA.

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Sterling, R.S., Krushinski, E.M. & Pellegrini, V.D. THA After Acetabular Fracture Fixation: Is Frozen Section Necessary?. Clin Orthop Relat Res 469, 547–551 (2011). https://doi.org/10.1007/s11999-010-1612-1

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  • DOI: https://doi.org/10.1007/s11999-010-1612-1

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