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

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

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Department of Orthopedics, HaEmek Medical Center, Afula, Israel.



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


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


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.


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.


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

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