Meta-analysis of unexpected findings in routine histopathology during total joint replacement

Isr Med Assoc J. 2011 Feb;13(2):80-3.


Background: Routine histopathological analysis of bone extracted during total joint replacement is controversial.

Objectives: To evaluate the utility of routine histopathological analysis in total joint replacement.

Methods: We calculated the risk for discrepant diagnosis between the pre- and postoperative histopathological results by performing a meta-analysis of 11 studies (including our data). We also calculated the risk for significant discrepancies.

Results: The discrepant diagnoses analysis showed a random effect of 3% discrepancies (95% confidence interval 1.2-3.7%). Funnel plot indicates a publication bias; consequently, the conclusions from this analysis should be interpreted with caution. Regarding the significant discrepancy in diagnosis, we performed a meta-analysis of nine studies. Fixed-effects analysis of all the studies resulted in 0.16% significant discrepancies (95% CI 0.02-0.30%) with no heterogeneity (Q = 3.93, degrees of freedom = 9, P = 0.14, /2 = 49.2%), and appropriate fixed-effects models.

Conclusions: We recommend no further routine histological examination, reserving this tool for cases with a controversial primary diagnosis and unexpected findings during the operation.

Publication types

  • Meta-Analysis

MeSH terms

  • Arthroplasty, Replacement*
  • Arthroplasty, Replacement, Ankle
  • Arthroplasty, Replacement, Hip
  • Arthroplasty, Replacement, Knee
  • Bone Neoplasms / epidemiology*
  • Bone and Bones / pathology*
  • Femur Head / pathology
  • Femur Head / transplantation
  • Humans
  • Incidental Findings*
  • Logistic Models
  • Neoplasms, Unknown Primary / epidemiology*
  • Neoplasms, Unknown Primary / pathology
  • Transplantation, Homologous