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

Abstract

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, 37–83 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 (<five PMNs). A relapse was defined as the occurrence of PJI. Median follow-up was 51 months (range, 32–80 months) following second-stage revision surgery.

Results

Intraoperative histopathological revealed that 8.0% of cases were PMNs-positive. Postoperative histopathological examination revealed that 28.0% of cases were PMNs-positive. 28.0% of cases showed discrepancy between the PMNs-positivity. Intraclass correlation coefficient indicates poor reproducibility. Infection relapse after revision surgery occurred in two cases (8.0%); both relapse cases were from the PMNs-negative group. There was no statistical relationship between the presence of PMNs in periprosthetic tissue by intraoperative or postoperative histopathological examination and relapse of infection.

Conclusions

Our findings showed that intraoperative histopathological examination could not predict the relapse of infection. Intraoperative histopathological examination promotes overdiagnosis of the requirement for re-implantation of antibiotic-impregnated cement and prolonged treatment periods.

Level of evidence

Level III, diagnostic study