Abstract
Introduction
It is standard practice to send samples for microbiological and histological analysis during revision surgery in suspected prosthetic joint infection. The aim of our study was to analyse the utility of histology in decision making in these patients.
Methods
We performed a retrospective review of all revision hip arthroplasty patients between from September 2013 and August 2016 from the hospital database. We analysed the results of aspiration, culture and sensitivity, histology from intra-operative samples and inflammatory markers. Diagnostic utility statistics were performed.
Results
135 revisions were included. The mean age of the patients was 64.2±2.34 years.114 patients had a single stage revision and 21 patients had more than one procedure. 4 patients grew organisms in 3/5 microscopy samples and 5 patients grew organisms in 1 or 2 samples. Histology showed infection in 4 patients. The sensitivity and specificity of microbiology tests in detecting infection were 90.9% and 93% respectively (positive predictive value ppv =58.8, negative predictive value npv = 99.2). The sensitivity and specificity for histology were 57.1% and 92.5% respectively (ppv = 40% and npv = 74.4%). The cost of performing histology analysis in these patients is £206.50. The financial savings if none of the patients had a histological analysis would have been £27877.50.
Discussion
Histology does not add any information to the results of microbiological analysis in prosthetic joint infection. It does not contribute to any change in the management. The cost of performing a histological analysis in one patient is substantial with no clinical utility.
Conclusion
We conclude that sending intra-operative samples for histology in addition to microbiological analysis has limited clinical utility and may be safely discontinued without any compromise in clinical decision making capacity and substantial financial savings.
