Department of Orthopaedic Surgery, Alrijne Healthcare Group, Leiderdorp, The Netherlands.
Department of Orthopaedic Surgery, Alrijne Healthcare Group, Leiderdorp, The Netherlands.
Orthop Traumatol Surg Res. 2022 Apr;108(2):102942. doi: 10.1016/j.otsr.2021.102942. Epub 2021 Apr 22.
Pathological examination of the femoral head after hip arthroplasty is often performed routinely. The cost-effectiveness of the examination with regard to identifying clinically relevant diagnoses has been a point of discussion. To date, recommendations on performing pathological examination based on patient characteristics, disease history or radiographic findings are scarce. The aim of this study was to gain insight in when to select a patient for pathological examination of the femoral head by means of the following research questions: "How many clinically relevant diagnoses does selective pathological examination identify?" "Which factors contribute to selection of the femoral head for conducting pathological examination?" "What are the costs of selective pathological examination for identifying clinically relevant diagnoses?"
Selective pathological examination of the femoral head results in higher ratios of identified clinically relevant diagnoses against substantially lower costs.
A retrospective cohort study was performed over the period of 2010-2015. All pathological reports were collected from our hospital and screened for resected femoral heads after primary total hip arthroplasty (THA) or primary hemiarthroplasty (HA). The coherence between preoperative diagnosis and postoperative pathological diagnosis was defined as concordant, discrepant or discordant. The aim was to perform logistic regression analysis.
In total, 164 patients were included of 3998 hip arthroplasties performed during the study period with a mean age of 74±12.3 years including 54 (33%) male and 110 (67%) female of whom 112 (68%) underwent THA and 52 (32%) HA. A discrepancy in diagnosis was found in nine patients (6%) and discordance in three patients (2%). The most frequently reported reasons to perform pathological examination were malignancy in medical history n=86 (53%), avascular necrosis n=22 (13%), bone abnormality perioperatively n=19 (11%) and pathological fracture n=13 (8%). The factors that identified the unexpected clinically relevant diagnoses were pathological fracture (3 cases out of 13), bone abnormality perioperatively (2 out of 19), abnormalities on preoperative radiographs (1 out of 9) and to a lesser extent malignancy in history (2 out of 86). With costs of pathological examination of approximately €163 per femoral head, performed in 164 patients, the total costs of pathological examination resulted in €26,732. The cost per discrepant case (n=9) was €2970 and the cost per discordant case (n=3) was €8910.
Selective pathological examination of the femoral head following hip arthroplasty results in higher ratios of discrepant and discordant cases against substantially lower costs. Factors that identify clinically relevant diagnoses are pathological fracture, perioperative bone abnormality, abnormalities on preoperative radiographs and to a lesser extent malignancy in history.
III; retrospective cohort study.
髋关节置换术后常对股骨头进行病理检查。该检查在识别临床相关诊断方面的成本效益一直是讨论的焦点。迄今为止，针对基于患者特征、病史或影像学发现进行病理检查的建议还很少。本研究旨在通过以下研究问题来深入了解何时选择患者进行股骨头的病理检查：“选择性病理检查可识别出多少临床相关诊断？” “哪些因素有助于选择进行病理检查的股骨头？” “选择性病理检查识别临床相关诊断的成本是多少？”
选择性股骨头病理检查可提高识别临床相关诊断的比例，并显著降低成本。
回顾性队列研究于 2010 年至 2015 年进行。从我院收集所有病理报告，并筛选出原发性全髋关节置换术（THA）或半髋关节置换术（HA）后切除的股骨头。术前诊断与术后病理诊断的一致性定义为一致、不一致或不一致。目的是进行逻辑回归分析。
共纳入 3998 例髋关节置换术中的 164 例患者，平均年龄 74±12.3 岁，包括 54 例（33%）男性和 110 例（67%）女性，其中 112 例（68%）接受 THA，52 例（32%）接受 HA。在 9 例患者（6%）中发现诊断不一致，在 3 例患者（2%）中发现不一致。进行病理检查的最常见原因是病史中有恶性肿瘤 n=86（53%）、缺血性坏死 n=22（13%）、围手术期骨异常 n=19（11%）和病理性骨折 n=13（8%）。确定意外临床相关诊断的因素是病理性骨折（13 例中有 3 例）、围手术期骨异常（19 例中有 2 例）、术前影像学异常（9 例中有 1 例），以及程度较轻的病史恶性肿瘤（86 例中有 2 例）。对 164 例患者进行的股骨头病理检查费用约为 163 欧元/例，病理检查总费用为 26732 欧元。不符合病例（n=9）的成本为 2970 欧元，不一致病例（n=3）的成本为 8910 欧元。
髋关节置换术后选择性股骨头病理检查可提高不一致和不一致病例的比例，并显著降低成本。确定临床相关诊断的因素是病理性骨折、围手术期骨异常、术前影像学异常，以及程度较轻的病史恶性肿瘤。
III；回顾性队列研究。
