The Role of Intraoperative Frozen Section as a Guide to Sepsis in Hip Arthroplasty for Teatment of painful Hip Disease

Yune, Seung Ho; Hwang, Deuk Soo; Kim, Hyeong Seong; Song, Jae Gie; Kim, Jin Man

Abstract

We performed a retrospective analysis of twenty-four consecutive hip arthroplasties (Total Hip Arthroplasty 18, Bipolar Arthroplasty 1, Cup revision 5) during which intraoperative frozen sections were analyzed to identify the occult active infection. We also reviewed the data such as laboratory findings (ESR, CRP), intraoperative culture, hip joint sonographic evaluation and permanent histologic section. Among the twenty-four patients those who received hip arthroplasties, 10 cases received revisional hip arthroplasties due to painful hip prosthesis loosening, 9 cases with infected hip prosthesis, 3 cases with infection after open reduction and internal fixation due to hip fracture and 2 cases with septic hip sequelae. Intraoperative frozen section had been obtained during staged revisional hip arthroplasties to determine the presence of active infection. We considered positive for infection if it shows more than 10 PML/HPF (Polymorphonuclear leukocyte /high power field) in at least 5 distinct microscopic fields from intraoperative tissue frozen section and postponed implantation of prosthesis. If it shows less than 5 PML/HPF, we performed revisional hip prosthesis implantation. We decided the implantation based on patient's condition, laboratory findings and intraoperative tissue conditions if it shows between 5 and 10 PML/HPF from intraoperative frozen section. At last follow up, 20 of 21 patients who had a revisional hip arthroplasties as below 10 PML/HPF from intraoperative frozen section remained free of infection (Specificity; 95%). We concluded that analysis of the intraoperative frozen sections is a reliable predictor as a guide to sepsis for the successful hip joint arthroplasties.