Polymorphonuclear cell count on frozen section is not an absolute index of reimplantation in infected total knee arthroplasty

Abstract

We evaluated the outcomes in 15 patients with infected total knee arthroplasty (TKA) who underwent reimplantation following excision arthroplasty in the presence of five to twenty polymorphonuclear cells per high power field (hpf) on intraoperative frozen section. At a minimum of two years of follow-up, we achieved 100% infection eradication rate with normalization of C-reactive protein levels, no radiolucency on plain radiographs and no clinical evidence of recurred infection. Successful reimplantation for infected TKA is possible despite of the presence of five to twenty polymorphonuclear cells per hpf in intraoperative frozen section with clear appearance of the tissues in the operative field. Clinical and serological confirmations of infection eradication before reimplantation as well as healthy operative findings are equally important factors for a successful reimplantation.

Keywords: infection; intraoperative frozen sections; polymorphonuclear cell count; revision; total knee arthroplasty.