C Liewen1, V T Krenn2, R Dieckmann3, L Bause4, M Liebisch2, A Niemeier5, A Trampuz6, V Krenn7. 1. MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik Trier GmbH, Max-Planck-Straße 5, 54296, Trier, Germany. 2. Fakultät für Medizin, Sigmund Freud PrivatUniversität Wien, Vienna, Austria. 3. Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany. 4. St. Josef-Stift Sendenhorst, Sendenhorst, Germany. 5. Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 6. Center for Musculoskeletal Surgery (CMSC), Charité-Universitätsmedizin Berlin, Berlin, Germany. 7. MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik Trier GmbH, Max-Planck-Straße 5, 54296, Trier, Germany. Krenn@patho-trier.de.
Abstract
INTRODUCTION: The purpose of this study is to use the CD15 focus score (FS) to determine the sensitivity and specificity of bacterial infection persistence in spacer-based two-stage revision arthroplasty. METHODS: The analysis comprises 112 cases that were subjected to revision due to the presence of infection upon replacement of a joint endoprosthesis. The histopathological data were collected in accordance with the synovial-like interface membrane (SLIM) classification and the CD15-FS and correlated with the microbiological data (MD). The quantifying evaluation of the CD15-FS was performed without knowledge regarding the microbiological data (MD). Correlation with the MD was performed after a 14-day cultivation period. RESULTS: With a single evaluation (1 focus, field area: 1.2 mm2) with a score value of 42, the CD15-FS showed a sensitivity for the eradication of infections of 0.64 and a specificity of 0.79 (PPV = 0.5; NPV = 0.87). With tenfold evaluation (10 foci, field area: 12 mm2) with a score value of 220, the sensitivity for the eradication was 0.68, the specificity 0.91 (PPV = 0.7; NPV = 0.89). No statistically significant correlation between the score values and the different infectious species could be detected. Based on the MD in 112 cases the rate of infection eradication was 75%. Polymethylmethacrylate-particles (PMMA) were detected in the perispacertissue in 64 cases (58%). No significant correlation could be established between microbiological pathogen detection and the presence of PMMA. CONCLUSION: In all cases (n = 112), periimplant synovial tissue (SLIM) with variable fibroblastic cellularity, capillary proliferation, leukocytic infiltration, fibrin deposition, new formation of woven bone and detection of PMMA particles was observed. These cases were classified as type IX perispacer synovialis/SLIM: type IX‑A with histopathological infection eradication and type IX‑B with histopathological infection persistence.
INTRODUCTION: The purpose of this study is to use the CD15 focus score (FS) to determine the sensitivity and specificity of bacterial infection persistence in spacer-based two-stage revision arthroplasty. METHODS: The analysis comprises 112 cases that were subjected to revision due to the presence of infection upon replacement of a joint endoprosthesis. The histopathological data were collected in accordance with the synovial-like interface membrane (SLIM) classification and the CD15-FS and correlated with the microbiological data (MD). The quantifying evaluation of the CD15-FS was performed without knowledge regarding the microbiological data (MD). Correlation with the MD was performed after a 14-day cultivation period. RESULTS: With a single evaluation (1 focus, field area: 1.2 mm2) with a score value of 42, the CD15-FS showed a sensitivity for the eradication of infections of 0.64 and a specificity of 0.79 (PPV = 0.5; NPV = 0.87). With tenfold evaluation (10 foci, field area: 12 mm2) with a score value of 220, the sensitivity for the eradication was 0.68, the specificity 0.91 (PPV = 0.7; NPV = 0.89). No statistically significant correlation between the score values and the different infectious species could be detected. Based on the MD in 112 cases the rate of infection eradication was 75%. Polymethylmethacrylate-particles (PMMA) were detected in the perispacertissue in 64 cases (58%). No significant correlation could be established between microbiological pathogen detection and the presence of PMMA. CONCLUSION: In all cases (n = 112), periimplant synovial tissue (SLIM) with variable fibroblastic cellularity, capillary proliferation, leukocytic infiltration, fibrin deposition, new formation of woven bone and detection of PMMA particles was observed. These cases were classified as type IX perispacer synovialis/SLIM: type IX‑A with histopathological infection eradication and type IX‑B with histopathological infection persistence.
Authors: Jaiben George; Grzegorz Kwiecien; Alison K Klika; Deepak Ramanathan; Thomas W Bauer; Wael K Barsoum; Carlos A Higuera Journal: Clin Orthop Relat Res Date: 2016-07 Impact factor: 4.176
Authors: Arash Aalirezaie; Thomas W Bauer; Hangama Fayaz; William Griffin; Carlos A Higuera; Veit Krenn; Vincent Krenn; Miguel Molano; Dirk-Jan Moojen; Camilo Restrepo; AliSina Shahi; Igor Shubnyakov; Scott Sporer; Aree Tanavalee; Marco Teloken; Job Diego Velázquez Moreno Journal: J Arthroplasty Date: 2018-10-19 Impact factor: 4.757
Authors: Thomas W Bauer; Hany Bedair; Jonathan D Creech; Carl Deirmengian; Hannah Eriksson; Yale Fillingham; Grigor Grigoryan; Noreen Hickok; Veit Krenn; Vincent Krenn; Stergios Lazarinis; Lars Lidgren; Jess Lonner; Susan Odum; Jay Shah; AliSina Shahi; Noam Shohat; Majd Tarabichi; Annette W-Dahl; Montri D Wongworawat Journal: J Arthroplasty Date: 2018-10-19 Impact factor: 4.757
Authors: C J Della Valle; E Bogner; P Desai; J H Lonner; E Adler; J D Zuckerman; P E Di Cesare Journal: J Bone Joint Surg Am Date: 1999-05 Impact factor: 5.284
Authors: Jaiben George; Yaxia Zhang; Michael Jawad; Mhamad Faour; Alison K Klika; Thomas W Bauer; Carlos A Higuera Journal: J Arthroplasty Date: 2017-12-29 Impact factor: 4.757
Authors: Arthur Gontarewicz; Oliver Niggemeyer; Lars Tharun; Livia Grancicova; Wolfgang Rüther; Jozef Zustin Journal: BMJ Open Date: 2012-08-13 Impact factor: 2.692