Is It Safe to Implant Prosthesis When Frozen Section Reports Positive During Joint Arthroplasty? A Retrospective Cohort Study

ABSTRACT Background Periprosthetic joint infection (PJI) remains a devastating complication of joint arthroplasty. Although intraoperative frozen section histology (> 5 neutrophils/HPF) is incorporated into the 2018 MSIS diagnostic criteria, its prognostic value for predicting postoperative PJI remains controversial. Methods Primary or revision THA/TKA procedures in our hospital between January 1, 2015 and December 31, 2021 with intraoperative frozen section histologic results were eligible for inclusion. Association between intraoperative frozen section histology and postoperative PJI was investigated based on the medical records, and a similar analysis of C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR) was also performed. Results A total of 14,969 knee/hip procedures were identified. After case selection, 797 cases comprising 529 (66.4%) primary and 268 (33.6%) revision were included. According to our data, frozen section positivity showed no PJI association, both in primary (OR, 1.206 [95% CI, 0.133–10.914], P > 0.999) and revision procedures (OR, 1.287 [95% CI, 0.331–5.007], p = 0.717). Conversely, elevated CRP (OR, 15.196 [95% CI, 1.916–120.523], p = 0.001) and ESR (OR, 5.794 [95% CI, 1.4979–22.4129], p = 0.008) predicted PJI exclusively in revisions. Conclusions Therefore, isolated positive frozen section results should not be the sole basis for surgical strategy. Elevated CRP / ESR levels during revision surgery warrant heightened vigilance and consideration of extended anti‐infective treatment. Level of Evidence III.