RSS-Feed abonnieren
DOI: 10.1055/s-0038-1675341
Histological Findings in Infected and Noninfected Second Stage Revision Knee Arthroplasties
Publikationsverlauf
13. Mai 2018
16. September 2018
Publikationsdatum:
05. November 2018 (online)
![](https://www.thieme-connect.de/media/jks/201910/lookinside/thumbnails/10-1055-s-0038-1675341_18may0132oa-1.jpg)
Abstract
Tissues from a periprosthetic joint infection (PJI) of the knee contain a heavy neutrophil polymorph (NP) infiltrate (> 5 NPs per high-powered field [HPF] by Musculoskeletal Infection Society [MSIS] criteria). PJI of the knee can be treated by a two-stage procedure and our aim was to determine whether the MSIS histological criteria for PJI diagnosis are valid in a second-stage revision knee arthroplasty. Periprosthetic tissues from 45 second-stage revision knee cases were analyzed histologically by hematoxylin–eosin and chloroacetate esterase (CAE) staining for the identification of NPs. The number of NPs was determined semiquantitatively and results correlated with the microbiological and clinical findings. In 9 of the 45 cases, an organism was cultured in two or more samples, meeting MSIS microbiological criteria for a definite diagnosis of PJI; histologically, seven of these cases contained > 5 per NPs per HPF on average, with the remaining two cases containing 1 NP and 2 NPs per HPF. In noninfected second-stage revisions, NPs were not seen in 30 cases with 6 cases showing less than 1 NP per HPF on average. The sensitivity, specificity, accuracy, and positive and negative predictive values of MSIS histological criteria (> 5 NPs per HPF) to diagnose PJI were 78%, 100%, 96%, 100%, and 95%, respectively. MSIS histological criteria for the diagnosis of PJI are valid for most but not all infected second-stage revision knee arthroplasties. Correlation of histology with clinical, microbiology and other laboratory findings is required to establish a diagnosis of PJI in second-stage revision knee arthroplasties.
-
References
- 1 Salvati EA, Robinson RP, Zeno SM, Koslin BL, Brause BD, Wilson Jr PD. Infection rates after 3175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg Am 1982; 64 (04) 525-535
- 2 Phillips JE, Crane TP, Noy M, Elliott TSJ, Grimer RJ. The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br 2006; 88 (07) 943-948
- 3 Parvizi J, Ghanem E, Sharkey P, Aggarwal A, Burnett RSJ, Barrack RL. Diagnosis of infected total knee: findings of a multicenter database. Clin Orthop Relat Res 2008; 466 (11) 2628-2633
- 4 Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res 2001; ;( (392) 15-23
- 5 Blom AW, Brown J, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Infection after total knee arthroplasty. J Bone Joint Surg Br 2004; 86 (05) 688-691
- 6 Bozic KJ, Kurtz SM, Lau E. , et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010; 468 (01) 45-51
- 7 Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 2009; 91 (01) 128-133
- 8 Toms AD, Davidson D, Masri BA, Duncan CP. The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg Br 2006; 88 (02) 149-155
- 9 Insall JN, Thompson FM, Brause BD. Two-stage reimplantation for the salvage of infected total knee arthroplasty. 1983. J Bone Joint Surg Am 2002; 84-A (03) 490
- 10 Qasim SN, Swann A, Ashford R. The DAIR (debridement, antibiotics and implant retention) procedure for infected total knee replacement - a literature review. SICOT J 2017; 3: 2
- 11 Cha MS, Cho SH, Kim DH. , et al. Two-stage total knee arthroplasty for prosthetic joint infection. Knee Surg Relat Res 2015; 27 (02) 82-89
- 12 Parvizi J, Ghanem E, Menashe S, Barrack RL, Bauer TW. Periprosthetic infection: what are the diagnostic challenges?. J Bone Joint Surg Am 2006; 88 (4, Suppl 4): 138-147
- 13 Workgroup Convened by the Musculoskeletal Infection Society. New definition for periprosthetic joint infection. J Arthroplasty 2011; 26 (08) 1136-1138
- 14 Parvizi J, Gehrke T. ; International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection. J Arthroplasty 2014; 29 (07) 1331
- 15 Kubista B, Hartzler RU, Wood CM, Osmon DR, Hanssen AD, Lewallen DG. Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty. Int Orthop 2012; 36 (01) 65-71
- 16 Cochran AR, Ong KL, Lau E, Mont MA, Malkani AL. Risk of reinfection after treatment of infected total knee arthroplasty. J Arthroplasty 2016; 31 (09) , Suppl): 156-161
- 17 Kahlenberg CA, Hernandez-Soria A, Cross MB. Poor prognosis of patients treated for periprosthetic joint infection. HSS J 2017; 13 (01) 96-99
- 18 Kashima TG, Inagaki Y, Grammatopoulos G, Athanasou NA. Use of chloroacetate esterase staining for the histological diagnosis of prosthetic joint infection. Virchows Arch 2015; 466 (05) 595-601
- 19 Atkins BL, Athanasou N, Deeks JJ. , et al; The OSIRIS Collaborative Study Group. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. J Clin Microbiol 1998; 36 (10) 2932-2939
- 20 Pandey R, Drakoulakis E, Athanasou NA. An assessment of the histological criteria used to diagnose infection in hip revision arthroplasty tissues. J Clin Pathol 1999; 52 (02) 118-123
- 21 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 Joint Surg Am 2012; 94 (18) 1700-1711
- 22 Banit DM, Kaufer H, Hartford JM. Intraoperative frozen section analysis in revision total joint arthroplasty. Clin Orthop Relat Res 2002; (401) 230-238
- 23 Mirra JM, Amstutz HC, Matos M, Gold R. The pathology of the joint tissues and its clinical relevance in prosthesis failure. Clin Orthop Relat Res 1976; (117) 221-240
- 24 Athanasou NA, Pandey R, de Steiger R, Crook D, Smith PM. Diagnosis of infection by frozen section during revision arthroplasty. J Bone Joint Surg Br 1995; 77 (01) 28-33
- 25 Fehring TK, McAlister Jr JA. Frozen histologic section as a guide to sepsis in revision joint arthroplasty. Clin Orthop Relat Res 1994; (304) 229-237
- 26 Bori G, Soriano A, García S. , et al. Low sensitivity of histology to predict the presence of microorganisms in suspected aseptic loosening of a joint prosthesis. Mod Pathol 2006; 19 (06) 874-877
- 27 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; 474 (07) 1619-1626
- 28 Della Valle CJ, Bogner E, Desai P. , et al. Analysis of frozen sections of intraoperative specimens obtained at the time of reoperation after hip or knee resection arthroplasty for the treatment of infection. J Bone Joint Surg Am 1999; 81 (05) 684-689
- 29 Munemoto M, Inagaki Y, Tanaka Y, Grammatopoulos G, Athanasou NA. Quantification of neutrophil polymorphs in infected and noninfected second-stage revision hip arthroplasties. Hip Int 2016; 26 (04) 327-330
- 30 Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Parvizi J. Diagnosing periprosthetic joint infection: has the era of the biomarker arrived?. Clin Orthop Relat Res 2014; 472 (11) 3254-3262