Comparison of clinical and histologic diagnoses in 16,587 total joint arthroplasties: implications for orthopedic and pathologic practices.

Overview

OBJECTIVES: To confirm how often histologic diagnoses correspond to reported clinical diagnoses in patients undergoing total joint arthroplasties. METHODS: We compared the submitting operative diagnosis with the pathologic diagnosis in 16,587 total joint arthroplasties for the seven most common diagnoses. RESULTS: The discrepancy rates between the submitted operative and histologic diagnosis were 18.8% for 7,968 total hip replacements and 9.4% for 8,619 total knee replacements. In addition, 5.4% of hip joints and 1.4% of knee joints demonstrated discordant histologic findings that had not been suspected clinically and should have affected clinical management and patient outcomes. CONCLUSIONS: Our findings demonstrated significantly more diagnostic discrepancies and discordance than has been suggested by the previously published literature. A large part of the difference may be due to more careful diagnostic analyses of orthopedic specimens than in other institutions. These analyses include some diagnoses that are not often made elsewhere but may have important future implications for patients.