Meding J B, Ritter M A, Jones N L, Keating E M, Faris P M
The Center for Hip and Knee Surgery, Orthopaedics Indianapolis, Mooresville, Indiana 46158, USA.
J Arthroplasty. 2000 Jan;15(1):69-71. doi: 10.1016/s0883-5403(00)91233-6.
Total hip and total knee arthroplasties (n = 951) were retrospectively reviewed to determine the cost-effectiveness of routine pathologic examination of surgical specimens in primary total hip and total knee replacements. Discrepancies between the postoperative diagnosis and the final pathologic diagnoses were recorded. Of the 951 cases reviewed, 27 (2.8%) noted conflicting postoperative and pathologic diagnosis. In all cases, the discrepancy was between a postoperative diagnosis of osteoarthritis and pathologic diagnosis of avascular necrosis. No new cases of neoplasia or inflammatory arthropathy were noted based on the pathologic interpretation. Sixteen of these discrepancies (5.1%) and were noted in total hip arthroplasties, and 11 (1.7%) were noted in total knee arthroplasties. In no case was postoperative medical or surgical treatment altered. Based on this review, strong consideration should be given to the elimination of routine pathologic evaluation of surgical specimens during primary joint arthroplasty, leaving this pathologic evaluation optional, at the discretion of the orthopaedic surgeon, rather than mandatory.
对951例全髋关节和全膝关节置换术进行回顾性研究，以确定在初次全髋关节和全膝关节置换术中对手术标本进行常规病理检查的成本效益。记录术后诊断与最终病理诊断之间的差异。在951例接受审查的病例中，有27例（2.8%）的术后诊断与病理诊断存在冲突。在所有病例中，差异均存在于术后骨关节炎诊断与病理诊断的缺血性坏死之间。根据病理解释，未发现新的肿瘤或炎性关节病病例。其中16例差异（5.1%）见于全髋关节置换术，11例（1.7%）见于全膝关节置换术。在任何情况下，术后的药物或手术治疗均未改变。基于本次研究，在初次关节置换术中应慎重考虑取消对手术标本的常规病理评估，将此病理评估作为可选项，由骨科医生自行决定，而非强制要求。
