Intraoperative frozen section analysis and 99Tcm triplephase bone scanning for diagnosing periprosthetic infection in hip

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Abstract

BACKGROUND:

Conventional serological, imaging and laboratory diagnosis methods for diagnosing periprosthetic infection are difficult to achieve ideal sensitivity, specificity and accuracy. In particular, the differential diagnosis of septic loosening and aseptic loosening in late stage after prosthetic replacement lacks of commonly accepted diagnostic criteria. The combination of preoperative, intraoperative and postoperative diagnostic methods is of great significance in the identifying infection diagnosis and formulating renovation strategy.

OBJECTIVE:

To diagnose periprosthetic hip joint infection by combined use of preoperative 99Tcm triplephase bone scanning and intraoperative neutrophil count in frozen section analysis, and to compare with conventional diagnostic tools.

METHODS:

Between April 2008 and May 2013, 44 hip revision cases were enrolled. Combined with clinical symptoms and serological examination, 18 cases whose erythrocyte sedimentation rate and C-reactive protein increased were considered as clinically suspected infection group; 26 cases with normal serological examination were considered as clinically suspected aseptic loosening group. 99Tcm triplephase bone scanning was performed in all patients, and combined with intraoperative frozen section analysis. If both results were negative, the diagnosis was aseptic loosening and did one-stage revision surgery; otherwise, periprosthetic infection was detected and two-stage revision surgery was conducted. By postoperative follow-up serological indexes and surgery outcomes, statistics of work curve of subjects was used to evaluate the diagnostic values of 99Tcm triplephase bone scanning and frozen section analysis.

RESULTS AND CONCLUSION:

In 18 cases of clinically suspected infection group, 16 cases of preoperative 99Tcm triplephase bone scanning and intraoperative frozen section results were positive, so two-stage revision surgeries were performed; 2 cases with negative results received one-stage revision surgery after excluding infection. In 26 cases of clinically suspected aseptic loosening group, 25 cases of preoperative 99Tcm three-phase bone scanning and intraoperative frozen section results were negative, and diagnosed as aseptic loosening, so one-stage revision surgery was performed. One patient affected infection of staphylococcus aureus in one-sample of the three samples in postoperative microbiological pathogen detection, and diagnosed as periprosthetic infection, so one-stage revision surgery was carried out. After combined use of 99Tcm triplephase bone scanning and intraoperative frozen section analysis, performance curve area increased from 0.906 to 0.972, sensitivity of diagnosis of infection increased from 89% to 94%, specificity of diagnosis of infection increased from 92% to 100%. However, no significant difference was detected in diagnostic methods. These data indicated that adding the method of 99Tcm triplephase bone scanning and intraoperative frozen section analysis technique, on the basis of serological and other conventional diagnostic tools, can differentiate infections from aseptic loosening of hip prosthesis. Negative results of 99Tcm triplephase bone scan showed high correlation between the diagnosis of aseptic loosening of the prosthesis and good diagnostic value to exclude infection. Combining with intraoperative frozen section method has a very good clinical value for the revision surgery.

RESULTS AND CONCLUSION:

Subject headings: prostheses and implants; arthroplasty, replacement, hip; prosthesis-related infections

RESULTS AND CONCLUSION:

Funding: the Science and Technology Project of School of Medicine of Shanghai Jiao Tong University, No. 13XJ1003

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