Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
J Bone Joint Surg Am. 2012 Sep 19;94(18):1662-7. doi: 10.2106/JBJS.K.01600.
Intraoperative analysis of frozen tissue samples has been used to diagnose periprosthetic joint infection in revision total knee arthroplasty, but the precision and reliability of this test throughout staged revision arthroplasty have not been well characterized. We undertook this study to determine the rate of discrepancy between frozen and permanent histopathologic samples in the diagnosis of periprosthetic infection at both the index total knee arthroplasty revision procedure and the attempted reimplantation.
Seventy-six patients who underwent staged revision of a total knee arthroplasty for apparent infection had samples for frozen and permanent sections obtained at both the index revision procedure and subsequent reimplantation attempts. We investigated the rate of discrepancy between these frozen and permanent sections. The clinical and radiographic outcomes of patients with and without concordance between the frozen and permanent sections were reviewed.
Concordance was noted between 297 (97.7%) of the 304 frozen sections and the permanent sections. Seven discrepancies between diagnoses based on frozen and permanent sections were noted; however, additional samples in these patients were positive and management was not affected. Fewer discrepancies were found during the initial revision procedure (one of 92, 1%) compared with reimplantation (six of 212, 3%). The mean time to reimplantation was similar between patients with and without a discrepancy in diagnosis between the frozen and permanent sections (185 compared with 157 days). The rate of discrepancy between frozen and permanent histopathologic sections was low, and no discrepancy affected the final outcome of any patient.
The rate of discrepancy between frozen and permanent histopathologic samples was low for both index revision and reimplantation procedures. In rare instances of discrepancy, management should be unaffected provided a sufficient number of samples were collected.
在翻修全膝关节置换术中，已经使用冰冻组织样本的术中分析来诊断假体周围关节感染，但该检测在分期翻修关节置换术中的准确性和可靠性尚未得到很好的描述。我们进行这项研究是为了确定在初次全膝关节翻修手术和试图再植入时，冰冻和永久组织病理样本在诊断假体周围感染方面的差异率。
76 例因明显感染而行分期翻修全膝关节置换术的患者，在初次翻修手术和随后的再植入尝试时均获得了冰冻和永久切片样本。我们研究了这些冰冻和永久切片之间的差异率。回顾了冰冻和永久切片一致和不一致的患者的临床和影像学结果。
304 个冰冻切片中有 297 个（97.7%）与永久切片一致。在冰冻和永久切片的诊断中发现了 7 个差异，但在这些患者中增加的样本为阳性，且不会影响管理。在初次翻修手术中（92 例中的 1 例，1%）发现的差异比再植入手术（212 例中的 6 例，3%）少。在冰冻和永久切片诊断存在差异的患者与无差异的患者之间，再植入的平均时间相似（185 天与 157 天）。
在初次翻修和再植入手术中，冰冻和永久组织病理样本之间的差异率均较低。在罕见的差异情况下，如果采集了足够数量的样本，管理不应受到影响。
