Utility of Intraoperative Frozen Section in the Diagnosis of Periprosthetic Joint Infection

Aims: To evaluate the accuracy of intraoperative frozen section histopathology for diagnosing periprosthetic joint infection (PJI) during hip revision surgery, both for patients with and without recent trauma to the hip. Patients and methods: The study included all revision total hip replacement procedures where intraoperative frozen section histopathology had been used for the evaluation of infection in a single institution between 2008 and 2015. Musculoskeletal Infection Society criteria were used to define infection. 210 hips were included for evaluation. Prior to revision surgery, 36 hips had a dislocation or a periprosthetic fracture (group A), and 174 did not (group B). Results: The prevalence of infection was 14.3% (5.6% in group A and 16.1% in group B). Using Feldman criteria, the sensitivity of histopathology was 50.0%, specificity 47.1%, positive predictive value 5.3% and negative predictive value 94.1% in group A. The sensitivity of frozen section histopathology was 75.0%, specificity 96.5%, positive predictive value 85% and negative predictive value 95.3% in group B. Conclusions: Intraoperative frozen section histopathology is reliable for the diagnosis of PJI if no dislocation or periprosthetic fracture has occurred prior to hip revision surgery.

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The Utility of Frozen Section Histology in Diagnosing Periprosthetic Joint Infection in Revision Total Joint Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.12.051 ◽

2021 ◽

Author(s):

McKayla Kelly ◽

Shreeya Bahethi ◽

Mary King ◽

Benjamin Elstner ◽

Justin Turcotte ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Total Joint Arthroplasty ◽

Frozen Section ◽

Joint Infection ◽

Joint Arthroplasty ◽

Revision Total Joint Arthroplasty

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Reliability of intra-operative frozen section study in revision of infected hip arthroplasty

Arthroplasty ◽

10.1186/s42836-019-0016-2 ◽

2019 ◽

Vol 1 (1) ◽

Cited By ~ 1

Author(s):

Karan Doshi ◽

Deepesh Daultani ◽

M. Ajith Kumar ◽

Shantharam Shetty ◽

Shailesh Pai

Keyword(s):

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Frozen Section ◽

Joint Infection ◽

Cement Spacer ◽

High Power Field ◽

Section Study ◽

Thorough Debridement ◽

Revision Prosthesis ◽

Hip Arthroplasties

Abstract Introduction Frozen sections are extensively used to help in the diagnosis of periprosthetic joint infection during revision hip arthroplasty, though there are insufficient data in relation to its usefulness. Methods Twenty-one patients with infected hip arthroplasties were operated in the form of one or two-staged revision hip arthroplasties. A frozen section was obtained intra-operatively and > 5 PMN’s/ HPF was considered as a positive indicator of infection. If the frozen section was reported negative (≤5 PMN’s/HPF), the revision prosthesis was implanted after a thorough debridement and a wash. If the frozen section was reported as positive, post the debridement; a non-articulating antibiotic-loaded cement spacer was implanted for 8 weeks, supplemented with 3 weeks of intravenous antibiotics and 3 weeks of oral antibiotics. This was followed by an antibiotic-free interval of 2 weeks. The patient was taken up for a revision surgery once the frozen section study was negative (≤5 PMN’s/HPF). The patients were followed up for a minimum of 1 year to a maximum of 2 years after the revision for any evidence of infection (assessed clinically, serologically, and radiologically). Results Frozen section analysis of PMNs per high power field had a 100% specificity in our patients in detecting periprosthetic joint infection. Conclusion Frozen section study is a safe, rapid, cheap and reliable intra-operative modality to diagnose periprosthetic joint infection.

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Antibiotic-Loaded Bone Cement and Periprosthetic Joint Infection

Journal of Long-Term Effects of Medical Implants ◽

10.1615/jlongtermeffmedimplants.2013010238 ◽

2014 ◽

Vol 24 (2-3) ◽

pp. 89-97 ◽

Cited By ~ 29

Author(s):

Antonia F. Chen ◽

Javad Parvizi

Keyword(s):

Bone Cement ◽

Periprosthetic Joint Infection ◽

Joint Infection

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RESEARCH ON VALUE OF INTRAOPERATIVE FROZEN SECTION EXAMINATION OF THE COMMON TUMORS AT HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.6.8 ◽

2011 ◽

pp. 67-73

Author(s):

Cong Thuan Dang ◽

Thi Thu Thao Le

Keyword(s):

Sensitivity And Specificity ◽

Frozen Section ◽

Analysis Data ◽

Poor Quality ◽

University Hospital ◽

Frozen Sections ◽

Intraoperative Frozen Section ◽

Frozen Section Examination ◽

Incorrect Diagnosis ◽

The Common

Background: To evaluate the accuracy and the pitfalls of frozen section examination in diagnosis the common tumors at Hue University Hospital. Materials and method: A retrospective analysis data of 99 consecutive patients from 2007 to 2009 were evaluated and analyzed the major pitfalls. In our 99 patients, 100% cases we compared histological diagnosis on frozen sections with those on paraffin sections. Results: The majority of frozen section examinations were the thyroid lesions 37.4%, breast lesions 25.2%, lymph nodes 16.1%, ovary 9.1% and less common in other diseases (12.1%). The accuracy, sensitivity and specificity of the intraoperative frozen section examination were 93.9%, 89.1% and 98.1% respectively. The main factors causing incorrect diagnosis in frozen section are: Misinterpretation, poor quality of frozen sections, improper sampling in sectioning and difficult to result interpretation. Conclusion: The frozen section analysis of suspect lesions displays good sensitivity and specificity characteristics.

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Periprosthetic Joint Infection

BioMed Research International ◽

10.1155/2019/6834680 ◽

2019 ◽

Vol 2019 ◽

pp. 1-2

Author(s):

Bernd Fink ◽

Konstantinos Anagnostakos ◽

Heinz Winkler

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection

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Does Intra-articular Injection of the Ankle With Corticosteroids Increase the Risk of Subsequent Periprosthetic Joint Infection (PJI) Following Total Ankle Arthroplasty (TAA)? If So, How Long After a Prior Intra-articular Injection Can TAA Be Safely Performed?

Foot & Ankle International ◽

10.1177/1071100719857082 ◽

2019 ◽

Vol 40 (1_suppl) ◽

pp. 3S-4S

Author(s):

Ilker Uçkay ◽

Christopher B. Hirose ◽

Mathieu Assal

Keyword(s):

Periprosthetic Joint Infection ◽

Corticosteroid Injection ◽

Joint Infection ◽

Invasive Procedure ◽

Total Ankle Arthroplasty ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

Strong Consensus ◽

Healthcare Associated ◽

The Ideal

Recommendation: Every intra-articular injection of the ankle is an invasive procedure associated with potential healthcare-associated infections, including periprosthetic joint infection (PJI) following total ankle arthroplasty (TAA). Based on the limited current literature, the ideal timing for elective TAA after corticosteroid injection for the symptomatic native ankle joint is unknown. The consensus workgroup recommends that at least 3 months pass after corticosteroid injection and prior to performing TAA. Level of Evidence: Limited. Delegate Vote: Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus)

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Synovial Complement Factors in Patients with Periprosthetic Joint Infection after Undergoing Revision Arthroplasty of the Hip or Knee Joint

Diagnostics ◽

10.3390/diagnostics11030434 ◽

2021 ◽

Vol 11 (3) ◽

pp. 434

Author(s):

Frank Sebastian Fröschen ◽

Sophia Schell ◽

Matthias Dominik Wimmer ◽

Gunnar Thorben Rembert Hischebeth ◽

Hendrik Kohlhof ◽

...

Keyword(s):

Synovial Fluid ◽

Multiple Regression ◽

Complement System ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Expression Patterns ◽

Factor H ◽

Low Grade ◽

Complement Factors ◽

Fluid Levels

The role and diagnostic value of the synovial complement system in patients with low-grade periprosthetic joint infection (PJI) are unclear. We sought to evaluate, for the first time, the usefulness of synovial complement factors in these patients by measuring the individual synovial fluid levels of complement factors (C1q, C3b/iC3b, C4b, C5, C5a, C9, factor B, factor D, factor H, factor I, properdin, and mannose-binding lectin [MBL]). The patients (n = 74) were classified into septic (n = 28) and aseptic (n = 46). Receiver-operator characteristic curves and a multiple regression model to determine the feasibility of a combination of the tested cytokines to determine the infection status were calculated. The synovial fluid levels of C1q, C3b/C3i, C4b, C5, C5a, MBL, and properdin were significantly elevated in the PJI group. The best sensitivity and specificity was found for C1q. The multiple regression models revealed that the combination of C1q, C3b/C3i, C4b, C5, C5a, and MBL was associated with the best sensitivity (83.3%) and specificity (79.2%) for a cutoff value of 0.62 (likelihood ratio: 4.0; area under the curve: 0.853). Nevertheless, only a combined model showed acceptable results. The expression patterns of the complement factors suggested that PJI activates all three pathways of the complement system.

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