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Discrepancies Between Frozen and Paraffin Tissue Sections Have Little Effect on Outcome of Staged Total Knee Arthroplasty Revision for Infection
D. Alex Stroh, BS1; Aaron J. Johnson, MD1; Qais Naziri, MD1; Michael A. Mont, MD1
1 Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for D.A. Stroh: DAStroh@gmail.com. E-mail address for A.J. Johnson: AJJterps@gmail.com. E-mail address for Q. Naziri: qnaziri@gmail.com. E-mail address for M.A. Mont: mmont@lifebridgehealth.org
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Investigation performed at the Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Sep 19;94(18):1662-1667. doi: 10.2106/JBJS.K.01600
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Abstract

Background: 

Intraoperative analysis of frozen tissue samples has been used to diagnose periprosthetic joint infection in revision total knee arthroplasty, but the precision and reliability of this test throughout staged revision arthroplasty have not been well characterized. We undertook this study to determine the rate of discrepancy between frozen and permanent histopathologic samples in the diagnosis of periprosthetic infection at both the index total knee arthroplasty revision procedure and the attempted reimplantation.

Methods: 

Seventy-six patients who underwent staged revision of a total knee arthroplasty for apparent infection had samples for frozen and permanent sections obtained at both the index revision procedure and subsequent reimplantation attempts. We investigated the rate of discrepancy between these frozen and permanent sections. The clinical and radiographic outcomes of patients with and without concordance between the frozen and permanent sections were reviewed.

Results: 

Concordance was noted between 297 (97.7%) of the 304 frozen sections and the permanent sections. Seven discrepancies between diagnoses based on frozen and permanent sections were noted; however, additional samples in these patients were positive and management was not affected. Fewer discrepancies were found during the initial revision procedure (one of 92, 1%) compared with reimplantation (six of 212, 3%). The mean time to reimplantation was similar between patients with and without a discrepancy in diagnosis between the frozen and permanent sections (185 compared with 157 days). The rate of discrepancy between frozen and permanent histopathologic sections was low, and no discrepancy affected the final outcome of any patient.

Conclusions: 

The rate of discrepancy between frozen and permanent histopathologic samples was low for both index revision and reimplantation procedures. In rare instances of discrepancy, management should be unaffected provided a sufficient number of samples were collected.

Level of Evidence: 

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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