Histopathology of femoral head donations: a retrospective review of 6161 cases
Although total hip arthroplasty is one of the most common orthopaedic surgical procedures, it remains unclear whether histopathological examination of the excised femoral head adds to the quality of patient care. We propose that assessment of femoral heads resected during total hip arthroplasty and...
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Published in | Journal of bone and joint surgery. American volume Vol. 93; no. 16; p. 1500 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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United States
17.08.2011
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Abstract | Although total hip arthroplasty is one of the most common orthopaedic surgical procedures, it remains unclear whether histopathological examination of the excised femoral head adds to the quality of patient care. We propose that assessment of femoral heads resected during total hip arthroplasty and donated for allograft use may provide a profile of femoral head pathology that benefits total hip arthroplasty patients and bone donors.
We retrospectively analyzed the histological findings reported for 6161 femoral heads donated for allograft use between 1993 and 2006. Specimens obtained during total hip arthroplasty and specimens donated at death were reviewed. Follow-up investigations that resulted from abnormal histopathological findings were also reviewed. The Western Australian Cancer Registry was used to determine whether patients with a suspected neoplasm were subsequently diagnosed with such a disease. A retrospective review of the histopathological findings was conducted to evaluate and reclassify all previous observations of abnormalities.
One hundred and five femoral heads demonstrated abnormal or reactive histopathological features not reported prior to surgery and were rejected for allograft use. A reactive lymphocytic infiltrate, most likely due to osteoarthritis, was the most commonly identified feature (forty-five cases). Other features observed in twenty-seven cases were also most likely due to the presence of severe osteoarthritis. Ten femoral heads demonstrated plasmacytosis, which may have been related to osteoarthritis. Two patients were diagnosed with Paget's disease, and two, with rheumatoid arthritis. Nineteen patients had a suspected neoplasm. Of these nineteen, eight cases of non-Hodgkin's lymphoma or chronic lymphocytic leukemia and one case of myelodysplastic syndrome were confirmed on further investigation. One subsequently confirmed malignancy was detected per 770 femoral heads examined.
Our findings indicate that, even with a detailed medical history and careful physical examination, clinically important diseases including neoplasms and Paget's disease are observed in patients diagnosed with osteoarthritis prior to total hip arthroplasty. Histological examination plays an integral role in quality assurance in femoral head banking, and it also represents a possible early diagnostic test for bone and bone-marrow-related diseases in patients undergoing total hip arthroplasty. |
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AbstractList | Although total hip arthroplasty is one of the most common orthopaedic surgical procedures, it remains unclear whether histopathological examination of the excised femoral head adds to the quality of patient care. We propose that assessment of femoral heads resected during total hip arthroplasty and donated for allograft use may provide a profile of femoral head pathology that benefits total hip arthroplasty patients and bone donors.
We retrospectively analyzed the histological findings reported for 6161 femoral heads donated for allograft use between 1993 and 2006. Specimens obtained during total hip arthroplasty and specimens donated at death were reviewed. Follow-up investigations that resulted from abnormal histopathological findings were also reviewed. The Western Australian Cancer Registry was used to determine whether patients with a suspected neoplasm were subsequently diagnosed with such a disease. A retrospective review of the histopathological findings was conducted to evaluate and reclassify all previous observations of abnormalities.
One hundred and five femoral heads demonstrated abnormal or reactive histopathological features not reported prior to surgery and were rejected for allograft use. A reactive lymphocytic infiltrate, most likely due to osteoarthritis, was the most commonly identified feature (forty-five cases). Other features observed in twenty-seven cases were also most likely due to the presence of severe osteoarthritis. Ten femoral heads demonstrated plasmacytosis, which may have been related to osteoarthritis. Two patients were diagnosed with Paget's disease, and two, with rheumatoid arthritis. Nineteen patients had a suspected neoplasm. Of these nineteen, eight cases of non-Hodgkin's lymphoma or chronic lymphocytic leukemia and one case of myelodysplastic syndrome were confirmed on further investigation. One subsequently confirmed malignancy was detected per 770 femoral heads examined.
Our findings indicate that, even with a detailed medical history and careful physical examination, clinically important diseases including neoplasms and Paget's disease are observed in patients diagnosed with osteoarthritis prior to total hip arthroplasty. Histological examination plays an integral role in quality assurance in femoral head banking, and it also represents a possible early diagnostic test for bone and bone-marrow-related diseases in patients undergoing total hip arthroplasty. |
Author | Zheng, Ming H Mackie, Katherine E Bulsara, Max Robbins, Peter Zhou, Ziqiang |
Author_xml | – sequence: 1 givenname: Katherine E surname: Mackie fullname: Mackie, Katherine E organization: M508 Centre for Orthopaedic Research, School of Surgery, QEII Medical Centre, University of Western Australia, Nedlands, Western Australia 6009, Australia – sequence: 2 givenname: Ziqiang surname: Zhou fullname: Zhou, Ziqiang – sequence: 3 givenname: Peter surname: Robbins fullname: Robbins, Peter – sequence: 4 givenname: Max surname: Bulsara fullname: Bulsara, Max – sequence: 5 givenname: Ming H surname: Zheng fullname: Zheng, Ming H |
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CitedBy_id | crossref_primary_10_1016_j_arth_2016_08_017 crossref_primary_10_5858_arpa_2019_0128_OA crossref_primary_10_1093_ajcp_aqab067 crossref_primary_10_1016_j_artd_2023_101200 crossref_primary_10_5435_JAAOS_D_21_01053 crossref_primary_10_5371_hp_2022_34_1_56 crossref_primary_10_1007_s10561_015_9499_4 crossref_primary_10_3109_17453674_2012_747055 crossref_primary_10_1016_j_otsr_2021_102942 crossref_primary_10_1007_s00590_019_02440_4 |
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SubjectTerms | Adolescent Adult Aged Aged, 80 and over Arthroplasty, Replacement, Hip Femur Head - pathology Femur Head - transplantation Follow-Up Studies Humans Male Middle Aged Retrospective Studies Tissue and Organ Procurement |
Title | Histopathology of femoral head donations: a retrospective review of 6161 cases |
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