An approach to diagnosis in arthroplasty specimens

Optimal examination of arthroplasty specimens requires careful assessment of the macroscopic findings and in many cases the microscopic findings only serve to confirm the findings, occasionally adding further data. With optimized gross and microscopic examination, the discrepancy rate between preoperative clinical and radiological diagnosis and pathological is high (up to 19%). Careful macroscopic assessment is a fundamental step which is often poorly executed. Inadequate or inappropriate sectioning inevitably misses key features in some cases. Poor fixation and over- decalcification will preclude microscopic evaluation, even in the best hands. Recognition of unusual joint disease requires a working knowledge of the usual findings in the more common disorders. This paper addresses the diarthrodial synovial lined joint arthroplasty specimens of femoral head, femoral condyles, tibial plateau and humeral head, representing the hip, knee and shoulder joints, the commonest joints for which such procedures are performed. The information is applicable to all joints. It discusses the findings in more common disorders, most of which are elucidated with optimized gross examination and description.