J Knee Surg 2019; 32(10): 1015-1019
DOI: 10.1055/s-0038-1675341
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Histological Findings in Infected and Noninfected Second Stage Revision Knee Arthroplasties

Yoshinobu Uchihara
1   Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
,
Yusuke Inagaki
1   Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
,
Mitsuru Munemoto
1   Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
,
Yasuhito Tanaka
1   Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
,
Nicholas Athanasou
2   Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal and Clinical Laboratory Services, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, United Kingdom of Great Britain and Northern Ireland
› Author Affiliations
Further Information

Publication History

13 May 2018

16 September 2018

Publication Date:
05 November 2018 (online)

Abstract

Tissues from a periprosthetic joint infection (PJI) of the knee contain a heavy neutrophil polymorph (NP) infiltrate (> 5 NPs per high-powered field [HPF] by Musculoskeletal Infection Society [MSIS] criteria). PJI of the knee can be treated by a two-stage procedure and our aim was to determine whether the MSIS histological criteria for PJI diagnosis are valid in a second-stage revision knee arthroplasty. Periprosthetic tissues from 45 second-stage revision knee cases were analyzed histologically by hematoxylin–eosin and chloroacetate esterase (CAE) staining for the identification of NPs. The number of NPs was determined semiquantitatively and results correlated with the microbiological and clinical findings. In 9 of the 45 cases, an organism was cultured in two or more samples, meeting MSIS microbiological criteria for a definite diagnosis of PJI; histologically, seven of these cases contained > 5 per NPs per HPF on average, with the remaining two cases containing 1 NP and 2 NPs per HPF. In noninfected second-stage revisions, NPs were not seen in 30 cases with 6 cases showing less than 1 NP per HPF on average. The sensitivity, specificity, accuracy, and positive and negative predictive values of MSIS histological criteria (> 5 NPs per HPF) to diagnose PJI were 78%, 100%, 96%, 100%, and 95%, respectively. MSIS histological criteria for the diagnosis of PJI are valid for most but not all infected second-stage revision knee arthroplasties. Correlation of histology with clinical, microbiology and other laboratory findings is required to establish a diagnosis of PJI in second-stage revision knee arthroplasties.

 
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