It is essential to realize that this review of the literature was confined to patients having revision hip and knee arthroplasty, shoulder data were not included. It is also important to recognize that this paper did not analyze the utility of histopathology for different organisms.
In shoulder arthroplasty, the most common infecting organisms are Propionibacterium Acnes and Coagulase Negative Staph or Staph Epidermidis. These organisms, being normal residents on and in the skin, do not incite the local or systemic inflammatory response of Staph Aureus or Gram Negative organisms. Thus, they are much less likely to be associated with the finding of five or ten PMNs per high power field discussed in this article.
For hip and knee arthroplasty surgeons, this is an important article. For shoulder arthroplasty surgeons, it has yet to be shown that histopathology of frozen sections is sensitive or specific for diagnosing the presence of the organisms most commonly found at the time of revision surgery.
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