Routine pathological examination of surgical specimens from patients undergoing total hip and knee replacement.

Abstract

To The Editor: In Cost and Effectiveness of Routine Pathological Examination of Operative Specimens Obtained During Primary Total Hip and Knee Replacement in Patients with Osteoarthritis (2000;82: 1531-5), by Kocher et al., the authors concluded that routine pathological examination of surgical specimens from total hip and knee replacement should be abandoned. This conclusion fills me with some concern. Kocher et al. reviewed the concordance of clinical and pathological diagnoses determined from surgical specimens obtained during 1234 primary total knee and total hip replacements, and they performed a cost analysis of the routine pathological examination of surgical specimens. The authors suggested that only one patient with a discordant pathological diagnosis of changes of granulomatous inflammation underwent a change in management as a result of the histological diagnosis. New diagnoses of conditions such as rheumatoid arthritis, osteonecrosis, pseudogout, pigmented villonodular synovitis, hemochromatosis, hypercellular marrow, and gout were suggested to be irrelevant to future patient management. Findings of osteonecrotic changes in one hip may have implications for the other hip, as these changes often occur bilaterally. Pigmented villonodular synovitis is a tumor that has been shown to be a factor in early failure of total knee replacement1. Hemochromatosis has many possible long-term effects on all bodily systems and would certainly warrant follow-up by a hematologist despite early negative serum tests. The patients with hypercellular bone marrow in the study by Kocher et al. did not undergo a formal hematological work-up, which is a concern. In 1998, a paper on the same subject, written by my colleagues …