title: Meta-analysis of unexpected findings in routine histopathology during total joint replacement.
abstract: BACKGROUND
  Routine histopathological analysis of bone extracted during total joint replacement is controversial.
  
  
  OBJECTIVE
  To evaluate the utility of routine histopathological analysis in total joint replacement.
  
  
  METHODS
  We calculated the risk for discrepant diagnosis between the pre- and postoperative histopathological results by performing a meta-analysis of 11 studies (including our data). We also calculated the risk for significant discrepancies.
  
  
  RESULTS
  The discrepant diagnoses analysis showed a random effect of 3% discrepancies (95% confidence interval 1.2-3.7%). Funnel plot indicates a publication bias; consequently, the conclusions from this analysis should be interpreted with caution. Regarding the significant discrepancy in diagnosis, we performed a meta-analysis of nine studies. Fixed-effects analysis of all the studies resulted in 0.16% significant discrepancies (95% CI 0.02-0.30%) with no heterogeneity (Q = 3.93, degrees of freedom = 9, P = 0.14, /2 = 49.2%), and appropriate fixed-effects models.
  
  
  CONCLUSIONS
  We recommend no further routine histological examination, reserving this tool for cases with a controversial primary diagnosis and unexpected findings during the operation.
authors: Department of Orthopedics, HaEmek Medical Center, Afula, Israel. guy_ru@clalit.org.il
authors: Guy
authors: G
authors: Rubin
authors: Semion
authors: S
authors: Krasnyansky
authors: Israel
authors: I
authors: Gavish
authors: Irit
authors: I
authors: Elmalah
authors: Oren
authors: O
authors: Ben-Lulu
authors: Nimrod
authors: N
authors: Rozen
mesh_terms: D019643:Arthroplasty, Replacement; D058737:Arthroplasty, Replacement, Ankle; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001859:Bone Neoplasms / Q000453:epidemiology*; D001842:Bone and Bones / Q000473:pathology*; D005270:Femur Head / Q000473:pathology / Q000637:transplantation; D006801:Humans; D033162:Incidental Findings; D016015:Logistic Models; D009382:Neoplasms, Unknown Primary / Q000453:epidemiology* / Q000473:pathology; D014184:Transplantation, Homologous