Intraoperative evaluation of polymorphonuclear leukocyte during second-stage revision surgery promote overdiagnosis of persistent periprosthetic joint infection

Objective: The aim of this study was to evaluate whether intraoperative histopathological examination could predict the risk of relapse of infection in periprosthetic joint infections (PJI). Methods: The study included 25 patients (14 women and 11 men, with a mean age of 67.0 years (range, 37e83 years)), who had two-staged revision surgery for a PJI. Following prosthetic removal in the first stage, all patient underwent an intraoperative histopathological examination during the second stage. The patients were divided into PMNs-positive group ( five PMNs per high-powered field) or -negative group (

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17. Haddad FS, Sukeik M, Alazzawi S. Is single-stage revision according to a strict protocol effective in treatment of chronic knee arthroplasty infections? Clin Orthop Relat Res. 2015;1:8e14. https://doi.org/10.1007/s11999-014-3721-8.

16. Beswick AD, Elvers KT, Smith AJ, Gooberman-Hill R, Lovering A, Blom AW. What is the evidence base to guide surgical treatment of infected hip pros-theses? systematic review of longitudinal studies in unselected patients. BMC Med. 2012;10:18. https://doi.org/10.1186/1741-7015-10-18.

15. Masters JP, Smith NA, Foguet P, Reed M, Parsons H, Sprowson AP. A systematic review of the evidence for single stage and two stage revision of infected knee replacement. BMC Musculoskelet Disord. 2013;14:222. https://doi.org/10.1186/ 1471-2474-14-222.

14. Leonard HA, Liddle AD, Burke O, Murray DW, Pandit H. Single- or two-stage revision for infected total hip arthroplasty? A systematic review of the literature. Clin Orthop Relat Res. 2014;3:1036e1042. https://doi.org/10.1007/s11999-013-3294-y.

13. Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD, Team I. Re-infection outcomes following one- and two-stage surgical revision of infected hip prosthesis: a systematic review and meta-analysis. PLoS One. 2015;9: e0139166. https://doi.org/10.1371/journal.pone.0139166.

12. Wu C, Qu X, Mao Y, et al. Utility of intraoperative frozen section in the diag-nosis of periprosthetic joint infection. PLoS One. 2014;7:e102346. https:// doi.org/10.1371/journal.pone.0102346.

11. Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of pros-thetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;1:e1ee25. https://doi.org/10.1093/cid/ cis803.

10. Setoguchi T, Kawakami H, Ishidou Y, et al. Cut-off values of latent infection in patients with rapid migration following bipolar hip hemiarthroplasty. BMC Musculoskelet Disord. 2016;1:37. https://doi.org/10.1186/s12891-016-0876-3.

9. Ko PS, Ip D, Chow KP, Cheung F, Lee OB, Lam JJ. The role of intraoperative frozen section in decision making in revision hip and knee arthroplasties in a local community hospital. J Arthroplasty. 2005;2:189e195. https://doi.org/10.1016/ j.arth.2004.06.034.

8. Osmon DR, Berbari EF, Berendt AR, et al. Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56:1e10. https:// doi.org/10.1093/cid/cis966, 2012/12/12 ed.

7. Kwiecien G, George J, Klika AK, Zhang Y, Bauer TW, Rueda CA. Intraoperative frozen section histology: matched for musculoskeletal infection society criteria. J Arthroplasty. 2017;1:223e227. https://doi.org/10.1016/j.arth.2016.06.019.

6. George J, Kwiecien G, Klika AK, et al. Are frozen sections and MSIS criteria reliable at the time of reimplantation of two-stage revision arthroplasty? Clin Orthop Relat Res. 2016;7:1619e1626. https://doi.org/10.1007/s11999-015-4673-3.

5. Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection: from the workgroup of the musculoskeletal infection society. Clin Orthop Relat Res. 2011;11:2992e2994. https://doi.org/10.1007/s11999-011-2102-9.

4. Tsaras G, Maduka-Ezeh A, Inwards CY, et al. Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. J Bone Jt Surg Am. 2012;18:1700e1711. https://doi.org/10.2106/JBJS.J.00756.

3. Moore AJ, Blom AW, Whitehouse MR, Gooberman-Hill R. Managing uncertainty e a qualitative study of surgeons' decision-making for one-stage and two-stage revision surgery for prosthetic hip joint infection. BMC Musculoskelet Disord. 2017;1:154. https://doi.org/10.1186/s12891-017-1499-z.

2. Hsieh PH, Shih CH, Chang YH, Lee MS, Shih HN, Yang WE. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am. 2004;86:1989e1997. https://doi.org/10.2106/00004623-200409000-00018.

1. Chen AF, Heller S, Parvizi J. Prosthetic joint infections. Surg Clin North Am. 2014;6:1265e1281. https://doi.org/10.1016/j.suc.2014.08.009.
Acta Orthopaedica et Traumatologica Turcica-Cover
  • ISSN: 1017-995X
  • Başlangıç: 2015
  • Yayıncı: Türk Ortopedi ve Travmatoloji Derneği
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