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Usefulness of Histological Analysis for Predicting the Presence of Microorganisms at the Time of Reimplantation After Hip Resection Arthroplasty for the Treatment of Infection
Guillem Bori, MD1; Alex Soriano, PhD1; Sebastián García, PhD1; Carme Mallofré, PhD1; Josep Riba, PhD1; Josep Mensa, MD1
1 Departments of Orthopaedics and Traumatology (G.B., S.G., and J.R.), Infectious Diseases (A.S. and J.M.), and Pathology (C.M.), Hospital Clinic, University of Barcelona, C/Villarroel 170, 08036 Barcelona (Catalunya), Spain. E-mail address for G. Bori: gbori@clinic.ub.es. E-mail address for A. Soriano: asoriano@clinic.ub.es. E-mail address for S. García: sgarcia@clinic.ub.es. E-mail address for C. Mallofré: cmallofre@clinic.ub.es. E-mail address for J. Riba: jriba@clinic.ub.es. E-mail address for J. Mensa: jmensa@clinic.ub.es
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Departments of Orthopaedics and Traumatology, Infectious Diseases, and Pathology, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Jun 01;89(6):1232-1237. doi: 10.2106/JBJS.F.00741
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Abstract

Background: Appropriate interpretation of a frozen section has a relatively high specificity and sensitivity for the diagnosis of infection when septic loosening of a prosthesis is suspected. However, its usefulness for predicting the presence of microorganisms at the time of reimplantation after hip resection arthroplasty for the treatment of infection is not well defined. The aim of the present study was to evaluate the usefulness of histological analysis in this situation.

Methods: From January 2002 to February 2006, a total of twenty-one patients underwent reimplantation after hip resection arthroplasty for the treatment of infection. Histological studies and cultures of specimens of periprosthetic tissue that had been obtained at the time of reimplantation were retrospectively reviewed. The results of culture were considered positive when the same microorganism was isolated in at least two samples. Two histological criteria were used to diagnose infection: (1) Criterion A (the Feldman criterion), defined as the presence of at least five neutrophils per high-power field (×400) in at least five separate microscopic fields and (2) Criterion B (the Athanasou criterion), defined as the presence of at least one neutrophil per high-power field (×400), on average, after examination of ten microscopic fields. The sensitivity, specificity, positive predictive value, and negative predictive value of each of these criteria were calculated with use of microbiological results as the gold standard for defining infection.

Results: Seven of the twenty-one patients had a positive result on culture, and the most common microorganism was coagulase-negative staphylococcus. The sensitivity, specificity, positive predictive value, and negative predictive value of frozen-section analysis were 28.5%, 100%, 100%, and 73.6%, respectively, according to the Feldman criterion and 71.4%, 64.2%, 50%, and 81.8%, respectively, according to the Athanasou criterion. The numbers of lymphocytes and plasma cells did not help in the diagnosis of infection. Fibrosis was more common in patients without an infection.

Conclusions: The probability of infection is high when at least five neutrophils per high-power field are found in the periprosthetic tissue, but it is not possible to rule out infection when the number of neutrophils is less than five.

Level of Evidence: Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    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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