JSES - 2026-05-21 - Journal Article
Donor-site morbidity and patient satisfaction after arthroscopic superior capsule reconstruction using fascia lata autograft for irreparable rotator cuff tears.
Hasegawa A, Uchida A, Noguchi Y, Shimizu H, Fukunishi K, Mihata T
Topics
Key Takeaway
In revision shoulder arthroplasty, synovial neutrophil percentage is the strongest preoperative diagnostic marker for PJI, with an optimal cutoff of 71.9–76.7% yielding an AUC of 0.707–0.714 for ICM Definite PJI.
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Summary
This multicenter study evaluated the diagnostic utility of synovial aspirate analysis and frozen sections in 425 consecutive revision shoulder arthroplasties using ICM Definite PJI criteria and two culture positivity thresholds (≥2 or ≥3). Synovial neutrophil percentage had the highest AUC (0.707–0.714) for Definite PJI with optimal cutoffs of 71.9–76.7%, while synovial cell count performed poorly (AUC 0.448–0.584). Frozen section showed moderate sensitivity (0.667–0.708) for Definite PJI but was insensitive for Non-Definite PJI (sensitivity 0.197–0.282).
Key Limitation
The paper's title and introduction describe a superior capsule reconstruction donor-site study, but the actual text reports a PJI diagnostic study — this mismatch raises serious concern about manuscript integrity or submission error, making all findings uninterpretable as presented.
Original Abstract
INTRODUCTION
The discriminatory utility of synovial aspirates and frozen sections in the evaluation of a failed shoulder arthroplasty is uncertain. We performed a multi-institutional study of consecutive revision shoulder arthroplasties to define the utility and optimal cutoffs of synovial aspirates and frozen sections to predict positive intraoperative cultures.
METHODS
Multicenter data was collected on 425 revision shoulder arthroplasties in which a synovial aspirate, frozen section, and a minimum of three deep intraoperative cultures were reported. Analysis was stratified based on International Consensus Meeting (ICM) Definite and Non-Definite PJI and two different thresholds of culture positivity (≥2 or ≥3). Receiver operating characteristic (ROC) curves were constructed, and area under the curve (AUC), optimal thresholds, and diagnostic utility for each test were calculated.
RESULTS
Fifty-five patients (13%) had Definite PJI per ICM criteria while 370 (87%) had Non-Definite PJI. Cutibacterium was the most common bacteria recovered in both Definite PJI and Non-Definite PJI. Synovial neutrophil percentage had the highest AUC at 0.707 and 0.714 for Definite PJI using a threshold of ≥2 and ≥3 positive cultures, respectively, and optimal cutoff values were 71.9% and 76.7%, respectively. For Non-Definite PJI, the AUC was 0.625 and 0.595 using a threshold of ≥2 and ≥3 positive cultures, respectively, with optimal cutoff values of 74.5% and 77.7%, respectively. Synovial cell count had poor discriminatory utility for Definite PJI (AUC 0.448-0.584) but slightly higher for Non-Definite PJI (AUC 0.600-0.664) with optimal cutoff of 3,800-4,100 cells. Frozen section had moderate discriminatory utility for Definite PJI (sensitivity 0.667-0.708, specificity 0.500-0.778) but poor sensitivity for Non-Definite PJI (sensitivity 0.197-0.282, specificity 0.943-0.948).
CONCLUSION
This is the first large-scale, multicenter study of consecutive revision shoulder arthroplasties analyzing the utility of synovial aspirate analysis and frozen sections. Synovial neutrophil percentage provided the greatest discriminatory utility with optimal cutoff values ranging from 71.9% to 77.7%. Frozen section also provided utility in predicting positive cultures in patients with Definite PJI.
LEVEL OF EVIDENCE
Level II; Diagnostic Study.