A comparison of postoperative microbiological and histological test results with the indication for revision as listed at the time of surgery in the National Joint Registry: a single-centre cohort study of metal-on-metal total hip replacement and hip resurfacing revision procedures.
| Autor: | Murphy TA; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK., Nandra R; The Royal Orthopaedic Hospital, Birmingham, UK., Berryman F; The Royal Orthopaedic Hospital, Birmingham, UK., Whitehouse MR; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK.; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK., Dunlop DJ; The Royal Orthopaedic Hospital, Birmingham, UK., Matharu GS; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK.; The Royal Orthopaedic Hospital, Birmingham, UK. |
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| Jazyk: | angličtina |
| Zdroj: | Hip international : the journal of clinical and experimental research on hip pathology and therapy [Hip Int] 2024 Dec 04, pp. 11207000241286791. Date of Electronic Publication: 2024 Dec 04. |
| DOI: | 10.1177/11207000241286791 |
| Abstrakt: | Introduction: Surgeons allocate an indication(s) for revision surgery on NJR Minimum Data Set forms in the immediate perioperative period, when results from intraoperative histology and microbiology samples are not available. We evaluated to what extent the postoperative diagnostics obtained for patients undergoing metal-on-metal hip arthroplasty (MoMHA) revision surgery align with the indication for revision listed in the NJR. Methods: NJR data for MoMHA revision patients (2004-2015) at a single centre were linked to hospital records of microbiology and histology testing for prosthetic joint infection (PJI) and adverse reaction to metal debris (ARMD). The Musculoskeletal Infection Society and Mirra classifications were used as "gold standards' to classify PJI and ARMD respectively and to assess the diagnostic accuracy of the clinician selected revision indication recorded on MDS forms. Results: Of 301 cases, 5.6% ( n = 17) and 3.7% ( n = 11) were revised for PJI and ARMD respectively. In a further 6.6% ( n = 20, PJI) and 15.6% ( n = 47, ARMD) the indication for revision selected at the time of surgery did not corroborate with the test results from intraoperative samples. Diagnostic accuracy analysis revealed sensitivity and specificity of indication for surgery at the time of revision for PJI of 35.5% (95% CI, 19.2-54.6) and 97.8% (CI, 54.6-95.2) respectively, and for ARMD of 7.41% (CI, 2.06-17.9) and 97.2% (CI, 94.3-98.9) respectively. Conclusions: We observed that the results of histology and microbiology analyses of intraoperative samples may provide evidence to support alternative diagnoses in 20% of cases. This indicates a need for a change in the work-up of these cases to allow a more accurate prediction of the indication for revision. Alternatively, if there was evidence of a difference in outcome for patients where the indication may be changed when such data becomes available, the feasibility of a facility to add additional information from samples taken intraoperatively when it becomes available should be explored. Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MRW: undertakes teaching on basic sciences for Orthopaedic trainees preparing for the FRCS. His institution receives market rate payment for this teaching from Heraeus. He undertakes teaching on total hip replacement for Orthopaedic Consultants and trainees. His institution receives market rate payment for this teaching from DePuy. He is PI on a commercially funded grant (CeramTec) investigating the outcome of ceramic bearings in total hip replacement. He is PI of the National Joint Registry lot 2 contract (statistical analysis) team.GSM: has received personal fees for undertaking medicolegal work for Leigh Day.All other authors declare that there is no conflict of interest. |
| Databáze: | MEDLINE |
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