Should we rely on frozen section during the reimplantation stage of revision knee arthroplasty?

Northern clinics of Istanbul Pub Date : 2024-04-22 eCollection Date: 2024-01-01 DOI:10.14744/nci.2023.90699
Aydan Kilicarslan, Kaan Yuksel, Nuran Sungu
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Abstract

Objective: To compare Frozen Section (FS) results during the reimplantation stage of revision knee arthroplasty, in patients without clinical signs of infection but with preoperative inconclusive serum inflammatory markers.

Methods: Sections were revisited the day after surgery. Intraoperative FS (iFS) was accepted as positive when the presence of >5 polymorphonuclear neutrophils (PMNLs) in 5 separate high-power fields was determined according to the consensus criteria of the International Consensus on Musculoskeletal Infection. The clinical outcomes, cultures and diagnostic values of iFS and review FS (rFS) were analyzed.

Results: No complications developed after reimplantation in 66 (84.6%) of the 78 evaluated patients. Complications developed in 12 patients, six of whom were treated with re-explantation, four with arthrodesis and two with above-the-knee amputation. Both iFS and rFS yielded insignificant sensitivity and specificity (25% and 45.5%, 25% and 45%, respectively). There was no statistically significant difference between definitive culture and iFS and rFS.

Conclusion: iFS evaluation is insufficient to exclude recovery from periprosthetic joint infection (PJI). Diagnosis of recurrence of infection in patients with indefinite serum inflammatory markers between the explantation and reimplantation interval remains challenging due to massive fibrosis that makes proper tissue sampling difficult. The attending physician should closely monitor clinical findings.

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在翻修膝关节置换术的再植阶段,我们是否应该依靠冷冻切片?
目的比较无临床感染迹象但术前血清炎症指标不确定的患者在翻修膝关节置换术再植入阶段的冰冻切片(FS)结果:方法:术后第二天重新检查切片。根据国际肌肉骨骼感染共识标准,术中FS(iFS)在5个独立的高倍视野中出现>5个多形核中性粒细胞(PMNL)即为阳性。对iFS和复查FS(rFS)的临床结果、培养和诊断价值进行了分析:结果:在78名接受评估的患者中,有66人(84.6%)在再植后未出现并发症。12名患者出现了并发症,其中6人接受了再植术,4人接受了关节置换术,2人接受了膝上截肢术。iFS和rFS的敏感性和特异性(分别为25%和45.5%,25%和45%)均不显著。结论:iFS评估不足以排除假体周围关节感染(PJI)复发的可能性。由于大量纤维化导致难以进行适当的组织取样,因此对于血清炎症标志物间隔时间不确定的患者,诊断感染复发仍具有挑战性。主治医生应密切关注临床结果。
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