Twenty‐three neutrophil granulocytes in 10 high‐power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening
Identifieur interne : 000A63 ( Istex/Corpus ); précédent : 000A62; suivant : 000A64Twenty‐three neutrophil granulocytes in 10 high‐power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening
Auteurs : Lars Morawietz ; Obbe Tiddens ; Michael Mueller ; Stephan Tohtz ; Tserenchunt Gansukh ; Joerg H. Schroeder ; Carsten Perka ; Veit KrennSource :
- Histopathology [ 0309-0167 ] ; 2009-06.
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Abstract
Aims: The histopathological diagnosis of infection in periprosthetic tissue from loose total joint endoprosthesis has been the subject of controversy. The aim was to define a histological criterion that would best differentiate between aseptic and septic endoprosthesis loosening.
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DOI: 10.1111/j.1365-2559.2009.03313.x
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Schroeder</name><affiliation><mods:affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Perka, Carsten" sort="Perka, Carsten" uniqKey="Perka C" first="Carsten" last="Perka">Carsten Perka</name><affiliation><mods:affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Krenn, Veit" sort="Krenn, Veit" uniqKey="Krenn V" first="Veit" last="Krenn">Veit Krenn</name><affiliation><mods:affiliation>Institute of Pathology, Trier, Germany</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:8BAF5897D0B6452CF58FADDAA4E720E60473870F</idno><date when="2009" year="2009">2009</date><idno type="doi">10.1111/j.1365-2559.2009.03313.x</idno><idno type="url">https://api.istex.fr/document/8BAF5897D0B6452CF58FADDAA4E720E60473870F/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000A63</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000A63</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Twenty‐three neutrophil granulocytes in 10 high‐power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening</title><author><name sortKey="Morawietz, Lars" sort="Morawietz, Lars" uniqKey="Morawietz L" first="Lars" last="Morawietz">Lars Morawietz</name><affiliation><mods:affiliation>Institute of Pathology</mods:affiliation></affiliation></author><author><name sortKey="Tiddens, Obbe" sort="Tiddens, Obbe" uniqKey="Tiddens O" first="Obbe" last="Tiddens">Obbe Tiddens</name><affiliation><mods:affiliation>Institute of Pathology</mods:affiliation></affiliation></author><author><name sortKey="Mueller, Michael" sort="Mueller, Michael" uniqKey="Mueller M" first="Michael" last="Mueller">Michael Mueller</name><affiliation><mods:affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Tohtz, Stephan" sort="Tohtz, Stephan" uniqKey="Tohtz S" first="Stephan" last="Tohtz">Stephan Tohtz</name><affiliation><mods:affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Gansukh, Tserenchunt" sort="Gansukh, Tserenchunt" uniqKey="Gansukh T" first="Tserenchunt" last="Gansukh">Tserenchunt Gansukh</name><affiliation><mods:affiliation>Medical Research Institute of Mongolia, Ulan Bator, Mongolia</mods:affiliation></affiliation></author><author><name sortKey="Schroeder, Joerg H" sort="Schroeder, Joerg H" uniqKey="Schroeder J" first="Joerg H" last="Schroeder">Joerg H. Schroeder</name><affiliation><mods:affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Perka, Carsten" sort="Perka, Carsten" uniqKey="Perka C" first="Carsten" last="Perka">Carsten Perka</name><affiliation><mods:affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</mods:affiliation></affiliation></author><author><name sortKey="Krenn, Veit" sort="Krenn, Veit" uniqKey="Krenn V" first="Veit" last="Krenn">Veit Krenn</name><affiliation><mods:affiliation>Institute of Pathology, Trier, Germany</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Histopathology</title><idno type="ISSN">0309-0167</idno><idno type="eISSN">1365-2559</idno><imprint><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2009-06">2009-06</date><biblScope unit="volume">54</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="847">847</biblScope><biblScope unit="page" to="853">853</biblScope></imprint><idno type="ISSN">0309-0167</idno></series><idno type="istex">8BAF5897D0B6452CF58FADDAA4E720E60473870F</idno><idno type="DOI">10.1111/j.1365-2559.2009.03313.x</idno><idno type="ArticleID">HIS3313</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0309-0167</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>endoprosthesis</term><term>histopathology</term><term>immunohistochemistry</term><term>infection</term><term>septic loosening</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Aims: The histopathological diagnosis of infection in periprosthetic tissue from loose total joint endoprosthesis has been the subject of controversy. The aim was to define a histological criterion that would best differentiate between aseptic and septic endoprosthesis loosening.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Lars Morawietz</name><affiliations><json:string>Institute of Pathology</json:string></affiliations></json:item><json:item><name>Obbe Tiddens</name><affiliations><json:string>Institute of Pathology</json:string></affiliations></json:item><json:item><name>Michael Mueller</name><affiliations><json:string>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</json:string></affiliations></json:item><json:item><name>Stephan Tohtz</name><affiliations><json:string>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</json:string></affiliations></json:item><json:item><name>Tserenchunt Gansukh</name><affiliations><json:string>Medical Research Institute of Mongolia, Ulan Bator, Mongolia</json:string></affiliations></json:item><json:item><name>Joerg H Schroeder</name><affiliations><json:string>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</json:string></affiliations></json:item><json:item><name>Carsten Perka</name><affiliations><json:string>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</json:string></affiliations></json:item><json:item><name>Veit Krenn</name><affiliations><json:string>Institute of Pathology, Trier, Germany</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>endoprosthesis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>histopathology</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>immunohistochemistry</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>infection</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>septic loosening</value></json:item></subject><articleId><json:string>HIS3313</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><qualityIndicators><score>4.295</score><pdfVersion>1.3</pdfVersion><pdfPageSize>595.276 x 782.362 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>281</abstractCharCount><pdfWordCount>3839</pdfWordCount><pdfCharCount>24235</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>38</abstractWordCount></qualityIndicators><title>Twenty‐three neutrophil granulocytes in 10 high‐power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening</title><refBibs><json:item><author><json:item><name>DJ Berry</name></json:item><json:item><name>WS Harmsen</name></json:item><json:item><name>ME Cabanela</name></json:item></author><host><volume>84</volume><pages><last>177</last><first>171</first></pages><author></author><title>J. 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Dis.</title></host><title>Recovery of small colony variants of Staphylococcus aureus following gentamicin bead placement for osteomyelitis</title></json:item></refBibs><genre><json:string>article</json:string></genre><host><volume>54</volume><publisherId><json:string>HIS</json:string></publisherId><pages><total>7</total><last>853</last><first>847</first></pages><issn><json:string>0309-0167</json:string></issn><issue>7</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1365-2559</json:string></eissn><title>Histopathology</title><doi><json:string>10.1111/(ISSN)1365-2559</json:string></doi></host><categories><wos><json:string>science</json:string><json:string>pathology</json:string><json:string>cell biology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>pathology</json:string></scienceMetrix></categories><publicationDate>2009</publicationDate><copyrightDate>2009</copyrightDate><doi><json:string>10.1111/j.1365-2559.2009.03313.x</json:string></doi><id>8BAF5897D0B6452CF58FADDAA4E720E60473870F</id><score>0.2560421</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/8BAF5897D0B6452CF58FADDAA4E720E60473870F/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/8BAF5897D0B6452CF58FADDAA4E720E60473870F/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/8BAF5897D0B6452CF58FADDAA4E720E60473870F/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Twenty‐three neutrophil granulocytes in 10 high‐power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><availability><p>© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Limited</p></availability><date>2009</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Twenty‐three neutrophil granulocytes in 10 high‐power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening</title><author xml:id="author-1"><persName><forename type="first">Lars</forename><surname>Morawietz</surname></persName><affiliation>Institute of Pathology</affiliation></author><author xml:id="author-2"><persName><forename type="first">Obbe</forename><surname>Tiddens</surname></persName><affiliation>Institute of Pathology</affiliation></author><author xml:id="author-3"><persName><forename type="first">Michael</forename><surname>Mueller</surname></persName><affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</affiliation></author><author xml:id="author-4"><persName><forename type="first">Stephan</forename><surname>Tohtz</surname></persName><affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</affiliation></author><author xml:id="author-5"><persName><forename type="first">Tserenchunt</forename><surname>Gansukh</surname></persName><affiliation>Medical Research Institute of Mongolia, Ulan Bator, Mongolia</affiliation></author><author xml:id="author-6"><persName><forename type="first">Joerg H</forename><surname>Schroeder</surname></persName><affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</affiliation></author><author xml:id="author-7"><persName><forename type="first">Carsten</forename><surname>Perka</surname></persName><affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</affiliation></author><author xml:id="author-8"><persName><forename type="first">Veit</forename><surname>Krenn</surname></persName><affiliation>Institute of Pathology, Trier, Germany</affiliation></author></analytic><monogr><title level="j">Histopathology</title><idno type="pISSN">0309-0167</idno><idno type="eISSN">1365-2559</idno><idno type="DOI">10.1111/(ISSN)1365-2559</idno><imprint><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2009-06"></date><biblScope unit="volume">54</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="847">847</biblScope><biblScope unit="page" to="853">853</biblScope></imprint></monogr><idno type="istex">8BAF5897D0B6452CF58FADDAA4E720E60473870F</idno><idno type="DOI">10.1111/j.1365-2559.2009.03313.x</idno><idno type="ArticleID">HIS3313</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Aims: The histopathological diagnosis of infection in periprosthetic tissue from loose total joint endoprosthesis has been the subject of controversy. The aim was to define a histological criterion that would best differentiate between aseptic and septic endoprosthesis loosening.</p></abstract><abstract><p>Methods and results: Neutrophilic granulocytes (NG) were enumerated histopathologically in 147 periprosthetic membranes obtained from aseptic and septic revision surgery, using periodic acid–Schiff (PAS) stains and CD15 immunohistochemistry. Cell numbers were correlated with the results of microbiological culture and the clinical diagnoses. Using receiver–operating characteristics, an optimized threshold was found at 23 NG in 10 high‐power fields (HPF). Using this threshold, histopathological examination had a sensitivity of 73% and specificity of 95% when compared with microbiological diagnosis (area under the curve 0.881), and a sensitivity of 77% and specificity of 97% when compared with clinical diagnosis (area under the curve 0.891).</p></abstract><abstract><p>Conclusions: We therefore recommend a counting algorithm with a threshold of ≥23 NG in 10 HPF (visual field diameter 0.625 mm) for the histopathological diagnosis of septic endoprosthesis loosening. If the enumeration of NG is difficult in conventional haematoxylin and eosin‐stained slides, CD15 immunohistochemistry should be performed, whereas the PAS stain has not proven to be helpful .</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>keywords</head><item><term>endoprosthesis</term></item><item><term>histopathology</term></item><item><term>immunohistochemistry</term></item><item><term>infection</term></item><item><term>septic loosening</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2009-06">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/8BAF5897D0B6452CF58FADDAA4E720E60473870F/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1365-2559</doi><issn type="print">0309-0167</issn><issn type="electronic">1365-2559</issn><idGroup><id type="product" value="HIS"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="HISTOPATHOLOGY">Histopathology</title></titleGroup></publicationMeta><publicationMeta level="part" position="06007"><doi origin="wiley">10.1111/his.2009.54.issue-7</doi><numberingGroup><numbering type="journalVolume" number="54">54</numbering><numbering type="journalIssue" number="7">7</numbering></numberingGroup><coverDate startDate="2009-06">June 2009</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="8" status="forIssue"><doi origin="wiley">10.1111/j.1365-2559.2009.03313.x</doi><idGroup><id type="unit" value="HIS3313"></id></idGroup><countGroup><count type="pageTotal" number="7"></count></countGroup><titleGroup><title type="tocHeading1">Original articles</title></titleGroup><copyright>© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Limited</copyright><eventGroup><event type="firstOnline" date="2009-06-01"></event><event type="publishedOnlineFinalForm" date="2009-06-01"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.2 mode:FullText source:FullText result:FullText" date="2010-03-06"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-27"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-23"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="847">847</numbering><numbering type="pageLast" number="853">853</numbering></numberingGroup><correspondenceTo>Dr Med. L Morawietz, Institute of Pathology, Charité University Hospital, Charitéplatz 1, D‐10117 Berlin, Germany. e‐mail: <email>lars.morawietz@charite.de</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:HIS.HIS3313.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Date of submission 31 August 2008 Accepted for publication 5 November 2008</unparsedEditorialHistory><countGroup><count type="figureTotal" number="3"></count><count type="tableTotal" number="0"></count></countGroup><titleGroup><title type="main">Twenty‐three neutrophil granulocytes in 10 high‐power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening</title><title type="shortAuthors"><i>L Morawietz et al.</i></title><title type="short"><i>Histology of endoprosthesis loosening</i></title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>Lars</givenNames><familyName>Morawietz</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1"><personName><givenNames>Obbe</givenNames><familyName>Tiddens</familyName></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a2"><personName><givenNames>Michael</givenNames><familyName>Mueller</familyName></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a2"><personName><givenNames>Stephan</givenNames><familyName>Tohtz</familyName></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#a3"><personName><givenNames>Tserenchunt</givenNames><familyName>Gansukh</familyName></personName></creator><creator creatorRole="author" xml:id="cr6" affiliationRef="#a2"><personName><givenNames>Joerg H</givenNames><familyName>Schroeder</familyName></personName></creator><creator creatorRole="author" xml:id="cr7" affiliationRef="#a2"><personName><givenNames>Carsten</givenNames><familyName>Perka</familyName></personName></creator><creator creatorRole="author" xml:id="cr8" affiliationRef="#a4"><personName><givenNames>Veit</givenNames><familyName>Krenn</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="a1"><unparsedAffiliation>Institute of Pathology</unparsedAffiliation></affiliation><affiliation xml:id="a2" countryCode="DE"><unparsedAffiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</unparsedAffiliation></affiliation><affiliation xml:id="a3" countryCode="MN"><unparsedAffiliation>Medical Research Institute of Mongolia, Ulan Bator, Mongolia</unparsedAffiliation></affiliation><affiliation xml:id="a4" countryCode="DE"><unparsedAffiliation>Institute of Pathology, Trier, Germany</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">endoprosthesis</keyword><keyword xml:id="k2">histopathology</keyword><keyword xml:id="k3">immunohistochemistry</keyword><keyword xml:id="k4">infection</keyword><keyword xml:id="k5">septic loosening</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><!-- Morawietz L, Tiddens O, Mueller M, Tohtz S, Gansukh T, Schroeder J H, Perka C & Krenn V
(2009) Histopathology 54, 847–853
Twenty-three neutrophil granulocytes in 10 high-power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening --><p><b>Aims: </b> The histopathological diagnosis of infection in periprosthetic tissue from loose total joint endoprosthesis has been the subject of controversy. The aim was to define a histological criterion that would best differentiate between aseptic and septic endoprosthesis loosening.</p><p><b>Methods and results: </b> Neutrophilic granulocytes (NG) were enumerated histopathologically in 147 periprosthetic membranes obtained from aseptic and septic revision surgery, using periodic acid–Schiff (PAS) stains and CD15 immunohistochemistry. Cell numbers were correlated with the results of microbiological culture and the clinical diagnoses. Using receiver–operating characteristics, an optimized threshold was found at 23 NG in 10 high‐power fields (HPF). Using this threshold, histopathological examination had a sensitivity of 73% and specificity of 95% when compared with microbiological diagnosis (area under the curve 0.881), and a sensitivity of 77% and specificity of 97% when compared with clinical diagnosis (area under the curve 0.891).</p><p><b>Conclusions: </b> We therefore recommend a counting algorithm with a threshold of ≥23 NG in 10 HPF (visual field diameter 0.625 mm) for the histopathological diagnosis of septic endoprosthesis loosening. If the enumeration of NG is difficult in conventional haematoxylin and eosin‐stained slides, CD15 immunohistochemistry should be performed, whereas the PAS stain has not proven to be helpful .</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1" numbered="no"><p>L.M and O.T. contributed equally to this work.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Twenty‐three neutrophil granulocytes in 10 high‐power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Histology of endoprosthesis loosening</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Twenty‐three neutrophil granulocytes in 10 high‐power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening</title></titleInfo><name type="personal"><namePart type="given">Lars</namePart><namePart type="family">Morawietz</namePart><affiliation>Institute of Pathology</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Obbe</namePart><namePart type="family">Tiddens</namePart><affiliation>Institute of Pathology</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Michael</namePart><namePart type="family">Mueller</namePart><affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Stephan</namePart><namePart type="family">Tohtz</namePart><affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Tserenchunt</namePart><namePart type="family">Gansukh</namePart><affiliation>Medical Research Institute of Mongolia, Ulan Bator, Mongolia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Joerg H</namePart><namePart type="family">Schroeder</namePart><affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Carsten</namePart><namePart type="family">Perka</namePart><affiliation>Centre for Musculoskeletal Surgery, Charité University Hospital, Berlin, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Veit</namePart><namePart type="family">Krenn</namePart><affiliation>Institute of Pathology, Trier, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2009-06</dateIssued><edition>Date of submission 31 August 2008 Accepted for publication 5 November 2008</edition><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">3</extent></physicalDescription><abstract>Aims: The histopathological diagnosis of infection in periprosthetic tissue from loose total joint endoprosthesis has been the subject of controversy. The aim was to define a histological criterion that would best differentiate between aseptic and septic endoprosthesis loosening.</abstract><abstract>Methods and results: Neutrophilic granulocytes (NG) were enumerated histopathologically in 147 periprosthetic membranes obtained from aseptic and septic revision surgery, using periodic acid–Schiff (PAS) stains and CD15 immunohistochemistry. Cell numbers were correlated with the results of microbiological culture and the clinical diagnoses. Using receiver–operating characteristics, an optimized threshold was found at 23 NG in 10 high‐power fields (HPF). Using this threshold, histopathological examination had a sensitivity of 73% and specificity of 95% when compared with microbiological diagnosis (area under the curve 0.881), and a sensitivity of 77% and specificity of 97% when compared with clinical diagnosis (area under the curve 0.891).</abstract><abstract>Conclusions: We therefore recommend a counting algorithm with a threshold of ≥23 NG in 10 HPF (visual field diameter 0.625 mm) for the histopathological diagnosis of septic endoprosthesis loosening. If the enumeration of NG is difficult in conventional haematoxylin and eosin‐stained slides, CD15 immunohistochemistry should be performed, whereas the PAS stain has not proven to be helpful .</abstract><subject lang="en"><genre>keywords</genre><topic>endoprosthesis</topic><topic>histopathology</topic><topic>immunohistochemistry</topic><topic>infection</topic><topic>septic loosening</topic></subject><relatedItem type="host"><titleInfo><title>Histopathology</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0309-0167</identifier><identifier type="eISSN">1365-2559</identifier><identifier type="DOI">10.1111/(ISSN)1365-2559</identifier><identifier type="PublisherID">HIS</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>54</number></detail><detail type="issue"><caption>no.</caption><number>7</number></detail><extent unit="pages"><start>847</start><end>853</end><total>7</total></extent></part></relatedItem><identifier type="istex">8BAF5897D0B6452CF58FADDAA4E720E60473870F</identifier><identifier type="DOI">10.1111/j.1365-2559.2009.03313.x</identifier><identifier type="ArticleID">HIS3313</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2009 The Authors. 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