Synovial tissue examination by frozen section as an indicator of infection in hip and knee arthroplasty in community hospitals.
Twenty-five surgical synovial sections were examined in 18 consecutive patients undergoing revision hip or knee arthroplasty (9 hips and 9 knees). All cases were performed in either of two community hospitals, with frozen-section tissue examined by multiple general pathologists. By protocol, acute inflammation was defined as more than five neutrophils per 60x high-power fields on multiple areas. A positive culture was defined as-organism growth from any surgical specimen. In each case, three surgical cultures and three frozen-section specimens were harvested from the synovium at corresponding periprosthetic surgical sites before antibiotics were administered. The average age of the patients was 68 years (range 40-87 years). There were 11 positive surgical cultures, 9 with positive frozen sections of synovium for acute inflammation (sensitivity, 82%; 95% confidence interval, 78-100%). There were 14 negative cultures; 13 had negative surgical frozen sections (specificity, 93%; 95% confidence interval, 83-100%). The positive predictive value of the test was 82%. There was accurate correlation between frozen section and culture in 22 of 25 cases (88%). In this community hospital setting, frozen section examination of surgical synovial tissue proved to be a reasonably sensitive and specific predictor of deep infection in revision hip and knee arthroplasty.
Pace
T B
TB
Carolina Orthopaedic Center, Greenville, SC 29615, USA.
Jeray
K J
KJ
Latham
J T
JT
D000368:Aged; D001424:Bacterial Infections / Q000473:pathology*; D003362:Cost-Benefit Analysis; D005260:Female; D005629:Frozen Sections / Q000191:economics; D006622:Hip Prosthesis / Q000009:adverse effects*; D006764:Hospitals, Community; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000473:pathology*; D012086:Reoperation; D012680:Sensitivity and Specificity; D013583:Synovial Membrane / Q000382:microbiology / Q000473:pathology*