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Intraoperative histology best used with other methods for diagnosis of revision elbow arthroplasty infection
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Researchers found that intraoperative histology had high specificity and high negative predictive value in the prediction of infection among 227 elbow arthroplasty revisions performed at the Mayo Clinic during an 8-year period.
The histology was determined to be consistent with acute inflammation in 33 of the procedures (14.6%), and it was considered true positive in 20 arthroplasty cases (8.8%) and true negative in 175 arthroplasty cases (77.1%).
However, Joaquin Sanchez-Sotelo, MD, and colleagues wrote in the study that intraoperative histology had “a low sensitivity and positive predictive value for predicting infection in the setting of revision elbow arthroplasty.”
"Intraoperative histology should be used in conjunction with other studies to definitively establish the diagnosis of infection in the setting of revision elbow arthroplasty," they wrote in the study.
The low sensitivity of intraoperative histology at 51.3% and its 85.9% accuracy led the investigators to further evaluate intraoperative histology in association with individual bacterial isolates. When the researchers compared the most commonly seen isolate — coagulase-negative Staphylococcus – with other isolates from infected elbows, they found intraoperative histology had a low 36.4% sensitivity.
"The data from our study have direct practical implications for the practicing orthopedic surgeon. Intraoperative histology had low sensitivity, meaning that a number of elbows having a positive intraoperative culture will have negative histological findings," the researchers wrote.
Disclosure: No external funding was used for any aspect of this study.
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