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Is Surgeon Assessed Bone Quality During Total Knee Arthroplasty a Valid Tool To Diagnose Osteoporosis ?

Adit Rajesh Maniar, MBBS, MS Orthopaedics, DNB Orthopaedics
INDIA

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Is Surgeon Assessed Bone Quality During Total Knee Arthroplasty a Valid Tool To Diagnose Osteoporosis ?

Adit Rajesh Maniar, MBBS, MS Orthopaedics, DNB Orthopaedics, INDIA Arpit Vasantbhai Bavaskar, MBBS, D.Orth., INDIA Vishal Raina, MS, INDIA Akshay Nayak, M.B.B.S, M.S , INDIA Ashwini Khokhar, MS, INDIA Rajesh Maniar, INDIA

Lilavati Hospital & Research Centre, Mumbai, Maharashtra, INDIA

2023 Congress ePoster Presentation 2023 Congress rating (1)

Anatomic Location

Knee

Anatomic Structure

Bones

Summary: Surgeon assessment of bone quality can help diagnose osteoporosis.

Introduction

Osteoporosis is a commonly encountered problem affecting outcomes after total knee arthroplasty(TKA). The current gold standard for diagnosing osteoporosis is bone mineral density(BMD) as measured by DEXA. This requires radiation exposure and is routinely performed at the hip, spine and radius. TKA affects the bone quality around the knee. A tool to diagnose the quality of bone at the knee joint without requiring radiation exposure would be extremely beneficial and reduce costs. We aim to investigate the diagnostic strength of subjective assessment of bone quality by an orthopaedic surgeon against the gold standard, bone mineral density measured by DEXA.

Methods

We prospectively enrolled 31 patients undergoing unilateral TKA. All patients undergoing bilateral and revision TKA were excluded. All patients underwent BMD by DEXA preoperatively. Intraoperatively, based on the bone quality, a single surgeon graded the bone on a VAS scale from 0 – 10, with 10 being the strongest bone. The surgeon was blinded to the BMD results. We divided the patients into 3 groups; normal, osteopenic and osteoporotic depending on the T score in the ipsilateral femoral neck. We correlated this T score with the VAS scale scoring. On the VAS scale we used a cutoff of 4 to define osteoporosis and 8 to define normal bone. We then tested the diagnosing power of these cutoffs in identifying osteoporotic and normal bones respectively.

Results

The spearman correlation co-efficient for VAS scale and BMD as measured by T score is 0.954 (p<0.001).
Surgeon conclusion of osteoporosis (VAS 4 and below) :
The diagnostic accuracy was 93.55%, sensitivity was 71.43%, specificity was 100%, positive predictive value was 100% and negative predictive value was 92.31%.
Surgeon conclusion of osteopenia or osteoporosis (VAS 7 and below) :
The diagnostic accuracy was 77.42%, the sensitivity was 70.83%, specificity 100%, positive predictive value 100% and negative predictive value 50%.

Conclusion

Intraoperative surgeon assessed bone quality has a strong correlation with BMD measured by DEXA. A VAS score of 4 or below has a 100 % specificity and positive predictive value along with a high negative predictive value and diagnostic accuracy for diagnosing osteoporosis. This can be used as a tool in diagnosing osteoporosis, eliminating the need for additional tests and radiation exposure. A VAS score of 7 and below has a 100 % specificity and positive predictive value for diagnosing osteopenia or osteoporotic bone. This may help identify normal bone, aiding the surgeon make better decisions regarding the implant fixation choice – cementless versus cemented.

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The Effect of Minor Adjustments to Tibial and Femoral Component Position on Soft Tissue Balance in Robotic Total Knee Arthroplasty ePoster Presentation Simon W. Young, MD, FRACS, NEW ZEALAND Matthew Carter, NEW ZEALAND Gavin William Clark, MBBS, FRACS, AUSTRALIA Christina Esposito, PhD, AUSTRALIA Matthew Walker, MBChB, FRACS, NEW ZEALAND
Effect of Altered Knee Joint Loading Pattern in Gait Biomechanics of Total Knee Arthroplasty Patient ePoster Presentation Sang Jin Lee, MD, PhD, KOREA, REPUBLIC OF
Patellar Medial-lateral Position can be Used to Correct the Effect of Leg Rotation on Preoperative Planning in Total Knee Arthroplasty for Varus Knees ePoster Presentation Shinichiro Nakamura, MD, PhD, JAPAN Shota Takemoto, MD, JAPAN Shinichi Kuriyama, MD, PhD, JAPAN Kohei Nishitani, MD, PhD, JAPAN Hiromu Ito, MD, PhD, JAPAN Mutsumi Watanabe, MD, PhD, JAPAN Young Dong Song, MD, PhD, UNITED STATES Shuichi Matsuda, MD, PhD, JAPAN
Golfers Have Greater Preoperative and Equal Postoperative Function When Undergoing Total Knee Arthroplasty Compared to Non-Golfers ePoster Presentation Patrick G Robinson, MBChB, MRCS, MS, MBA, UNITED KINGDOM Robert Kay, MBChB, UNITED KINGDOM Deborah Macdonald, BA(Hons), UNITED KINGDOM Andrew Murray, MBChB, FFSEM, UNITED KINGDOM Nick David Clement, MBBS, MD, PhD, FRCS(Orth), UNITED KINGDOM
Effect of Restricted Kinematic Alignment Total Knee Arthroplasty on Coronal Plane Alignment Of The Ankle Joint ePoster Presentation Bartosz Michał Maciąg, MD, POLAND Marcin Łapiński, MD, POLAND Tomasz Mrozek, MD, POLAND Adrian Góralczyk, MD, POLAND Maciej Swiercz, MD, POLAND Grzegorz Maciąg, POLAND Krystian Żarnovsky, POLAND Olga Adamska, POLAND Artur Stolarczyk, MD, PhD, POLAND
Factors Associated With Failure and Survivorship Following Unicompartmental Knee Arthroplasty: A Single-Center Experience ePoster Presentation Anirudh K Gowd, MD, UNITED STATES Johannes F. Plate, MD, PhD, UNITED STATES Asher Lichtig, MD, UNITED STATES Orhan Yanmis, MD, UNITED STATES Gary G. Poehling, MD, UNITED STATES
Total Knee Arthroplasty Without Patellar Component Replacement. Does it Increase the Risk of Revision? Local Experience Analysis ePoster Presentation Zoy Anastasiadis, MD, CHILE Diego Edwards, MD, CHILE Sergio Arellano, MD, CHILE Andrés Schmidt-Hebbel, MD, CHILE Eduardo Gardella, MD, CHILE Nicolás González-Kusjanovic, MD, MSc, CHILE Alex Vaisman, MD, Prof., CHILE
No Difference In Sports Participation And Patient-Reported Functional Outcomes Between Total Knee Arthroplasty And Unicompartmental Knee Arthroplasty At Minimum 2-Year Follow-Up In A Matched Control Study ePoster Presentation Amit Meena, MBBS, MS, DNB, INDIA Elisabeth Abermann, MD, AUSTRIA Christian Hoser, MD, AUSTRIA Luca Farinelli, MD, ITALY Caroline Hepperger, PhD, AUSTRIA Akshya Raj, MBBS,MS, INDIA Mohit Kumar Patralekh, MBBS, MS(Orthopaedics), DNB(Orthopaedics), MNAMS, INDIA Christian Fink, MD, Prof., AUSTRIA
Short Term Outcome of Tibial Defect Reconstruction In Primary Total Knee Arthroplasty: A Retrospective Study ePoster Presentation Sanjib Kumar Behera, MS (Orth), DNB (Rehab), DPMR, INDIA Madhumita Pradhan, BDS, MPH, MHA , INDIA Vikram Choudhary, MD, UNITED STATES
The Statistical Fragility of Tourniquet Use In Total Knee Arthroplasty: A Systematic Review ePoster Presentation Kyle William Lawrence, BS, UNITED STATES John K Cordero, MD, UNITED STATES Ashley Brown, BS, UNITED STATES Xinning Li, MD, UNITED STATES Brett Hayden, MD, UNITED STATES Robert L Parisien, MD, UNITED STATES
Clinical Comparison and Survival Rate Between Unicompartmental Knee Arthroplasty and High Tibial Osteotomy With An External Fixator For Varus Knee In Patients Younger Than 60 Years at Mid-Term Follow-Up ePoster Presentation Amit Kumar Yadav, M.S (Orth),DNB(Orth),MNAMS, UNITED KINGDOM Riccardo D'Ambrosi, MD, ITALY Mangal Parihar, MS Ortho, INDIA

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Is Surgeon Assessed Bone Quality During Total Knee Arthroplasty a Valid Tool To Diagnose Osteoporosis ?

Is Surgeon Assessed Bone Quality During Total Knee Arthroplasty a Valid Tool To Diagnose Osteoporosis ?

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Conclusion

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Is Surgeon Assessed Bone Quality During Total Knee Arthroplasty a Valid Tool To Diagnose Osteoporosis ?

Is Surgeon Assessed Bone Quality During Total Knee Arthroplasty a Valid Tool To Diagnose Osteoporosis ?

Introduction

Methods

Results

Conclusion

More 2023 ISAKOS Congress Content