Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis.
Background: The accuracy of intraoperative periprosthetic frozen section histologic evaluation in predicting a diagnosis of periprosthetic joint infection prior to microbiologic culture results is unknown.Methods: We performed a systematic review and meta-analysis of all longitudinal studies that co...
| Publicado en: | Journal of Bone & Joint Surgery, American Volume Vol. 94; no. 18; pp. 1700 - 1712 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research systematic review Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
9/19/2012
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108069979&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 108069979 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00219355 1H2 jtl: Journal of Bone & Joint Surgery, American Volume issn: 00219355 maglogo: N pubinfo: dt: 9/19/2012 vid: 94 iid: 18 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 108069979 108069979 NLM22992880 2011690290 NLM22992880 108069979 ppf: 1700 ppct: 12 formats: tig: atl: Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. aug: au: Tsaras G Maduka-Ezeh A Inwards CY Mabry T Erwin PJ Murad MH Montori VM West CP Osmon DR Berbari EF Tsaras, Geoffrey Maduka-Ezeh, Awele Inwards, Carrie Y Mabry, Tad Erwin, Patricia J Murad, M Hassan Montori, Victor M West, Colin P Osmon, Douglas R Berbari, Elie F affil: Department of Medicine, University of Illinois College of Medicine at Rockford, 1601 Parkview Avenue, Rockford, IL 61107, USA sug: subj: Arthroplasty, Replacement, Hip Adverse Effects Arthroplasty, Replacement, Knee Adverse Effects Frozen Sections Utilization Prosthesis-Related Infections Pathology Prosthesis-Related Infections Surgery Arthroplasty, Replacement, Hip Methods Arthroplasty, Replacement, Knee Methods Confidence Intervals Female Human Intraoperative Care Methods Male Meta Analysis Odds Ratio Postoperative Complications Pathology Postoperative Complications Surgery Probability Prospective Studies Prosthesis-Related Infections Diagnosis Reoperation Methods Risk Assessment Systematic Review Treatment Outcomes Female Male ab: Background: The accuracy of intraoperative periprosthetic frozen section histologic evaluation in predicting a diagnosis of periprosthetic joint infection prior to microbiologic culture results is unknown.Methods: We performed a systematic review and meta-analysis of all longitudinal studies that compared frozen section histologic results with simultaneously obtained microbiologic culture at the time of revision total hip or total knee arthroplasty. The data sources were Ovid MEDLINE, Ovid EMBASE, the Cochrane Library, ISI Web of Science, and SCOPUS, from the inception of each database to January 2010.Results: Twenty-six studies involving 3269 patients undergoing revision hip or knee arthroplasty met the inclusion criteria. A culture-positive periprosthetic joint infection was confirmed in 796 (24.3%) of the patients. Frozen section results, using any of the diagnostic criteria chosen by the investigating pathologist, had a pooled diagnostic odds ratio of 54.7 (95% confidence interval [CI], 31.2 to 95.7), a likelihood ratio of a positive test of 12.0 (95% CI, 8.4 to 17.2), and a likelihood ratio of a negative test of 0.23 (95% CI, 0.15 to 0.35) for the diagnosis of periprosthetic joint infection. Fifteen studies utilizing a threshold of five polymorphonuclear leukocytes (PMNs) per high-power field to define a positive frozen section had a diagnostic odds ratio of 52.6 (95% CI, 23.7 to 116.2), and six studies utilizing a diagnostic threshold of ten PMNs per high-power field had a diagnostic odds ratio of 69.8 (95% CI, 33.6 to 145.0). There was no significant difference between the diagnostic odds ratio or likelihood ratios associated with these thresholds. The moderate to high heterogeneity among the included studies was unexplained by variability in the study design, diagnostic criteria for acute inflammation, reference standard for periprosthetic joint infection, or prevalence of infection. This heterogeneity could be due to differences in the inclusion and exclusion criteria, tissue sampling error, experience or technique of the pathologists, number of microscopic fields visualized, and field diameter examined.Conclusions: Intraoperative frozen sections of periprosthetic tissues performed well in predicting a diagnosis of culture-positive periprosthetic joint infection but had moderate accuracy in ruling out this diagnosis. Frozen section histopathology should therefore be considered a valuable part of the diagnostic work-up for patients undergoing revision arthroplasty, especially when the potential for infection remains after a thorough preoperative evaluation. The optimum diagnostic threshold (number of PMNs per high-power field) required to distinguish periprosthetic joint infection from aseptic failure could not be discerned from the included studies. There was no significant difference between the diagnostic accuracy of frozen section histopathology utilizing the most common thresholds of five or ten PMNs per high-power field. pubtype: Academic Journal doctype: meta analysis research systematic review Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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