THE UTILITY OF HISTOLOGICAL EXAMINATION OF TISSUE REMOVED DURING ELECTIVE JOINT REPLACEMENT - A PRELIMINARY ASSESSMENT

The utility of histological examination of tissue removed during elect ive joint replacement has not been determined, During a one-year perio d, tissue removed during 168 total joint replacements was submitted fo r histological examination, The clinical and histological diagnoses, t he cost of the histological study, and the clinical course were determ ined for all joints, Degenerative joint disease, rheumatoid arthritis, and avascular necrosis accounted for 98 per cent of the histological diagnoses, There were sixteen discrepancies between the clinical and h istological diagnoses, The histological diagnosis did not affect the t reatment of fifteen of these joints, However, the treatment was altere d for one joint that had a clinical diagnosis of degenerative joint di sease and a histological diagnosis of osteomyelitis; on review; the in itial histological diagnosis was determined to be incorrect, In 1996 d ollars, the cost of histological examination for all 168 joints was $1 0,698.24, Although there would be considerable cost-savings on a popul ation basis if histological examination were not performed, this savin gs must be weighed against the effect of a misdiagnosis on the managem ent of a particular patient.