[23] Is Routine Histopathologic Examination of Femoral Heads Justified? A 10-Year Review of Clinicopathologic Discrepancies in Elective Hip Arthroplasty Specimens at Two Institutions

Kathryn B Brown, Luminita Rezeanu, Nivin Y Ishaq, Alexandra S Brown, Edward F DiCarlo, Michael J Klein. The University of Mississippi Medical Center, Jackson, MS; Weill Cornell Medical College, New York, NY; Hospital for Special Surgery, New York, NY

Background: The utility of routine histopathologic examination of hip arthroplasty specimens has long been a source of controversy between orthopedic surgeons and surgical pathologists. Absolute consensus does not exist as to the appropriate handling of these specimens. We examined the discrepancy rate between clinical and histopathologic diagnosis in hip arthroplasty specimens at two medical institutions to determine whether microscopic examination of femoral heads is indeed justified.
Design: A 10 year retrospective review of 8921 hip arthroplasty specimens was performed at two medical institutions. Clinical diagnosis was compared with final pathologic diagnosis for each case, and major and minor discrepancies were documented.
Results: Discrepancy rates for the individual institutions were 12.3% and 18.8%. Overall, there was a combined discrepancy rate of 18.1% between the submitted clinical and final pathologic diagnosis in a total of 1614 patients. 4.9% of all cases exhibited major discrepancies, in patients for whom the treatment and/or prognosis was altered following histopathologic diagnosis. The remaining discrepancies were considered minor, with more academic than clinical/therapeutic significance (e.g. osteoarthritis versus avascular necrosis of the femoral head). Major discrepancies included both clinically unsuspected histopathologic findings and suspected processes not confirmed by histopathologic examination. Table 1 lists major discrepancies.

Table 1. Major clinicopathologic discrepancies
DiagnosisClinically unsuspectedClinically suspected but not identified histopathologically
Malignancy284
Pigmented villonodular synovitis191
Enchondroma270
Bone island670
Degenerative joint disease in hip dysplasia29150
Osteomyelitis21



Conclusions: Clinical and histopathologic diagnoses of hip arthroplasty specimens were compared at two separate institutions, yielding a relatively high overall discrepancy rate of 18.1%. 4.9% of all cases harbored major discrepancies, which included but were not limited to: 32 malignancies, 20 cases of pigmented villonodular synovitis, and 3 cases of osteomyelitis. These major diagnostic discrepancies significantly altered management and/or long-term prognosis. Consequently, histopathologic examination of all hip arthroplasty specimens is, in our opinion, highly justified.
Category: Bone & Soft Tissue

Monday, March 19, 2012 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 8, Monday Morning

 

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