Reassessment of the usefulness of frozen section analysis for hip and knee joint revisions

Intraoperative frozen section (FS) consultation is used in evaluating possible infection in cases of hip and knee revision arthroplasty, serving as an adjunct to preoperative and intraoperative studies. We examined our experience for more than 11 years to determine if FS examination had value sections were sent unselectively. We reviewed 244 cases, 132 with available culture results. The criterion for the presence of acute inflammation was more than 5 polymorphonuclear leukocytes per high-power field (hpf) in at least 5 seperate hpfs, excluding surface inflammatory exudate and fibrin. Only 27 cases (11.1%) demostrated positive FS or paraffin section results. In comparison with intraoperative culture, the sensitivity, specificity, positive predictive value, and negative predictive value for FS analysis alone (on review) were 29%, 95%, 40% and 92%. As currently used, FS analysis has excellent specificity and negative predictive value but poor sensitivity and positive predictive value. We suggest that FS examination be used more selectively in conjunction with other studies, namely erthrocyte sedimentation rate and C-reactive protein.