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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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Large Reduction In Postoperative Posterior Tibial Slope Risks Anterior Collapse Of The Tibial Component In Fixed-Bearing Unicompartmental Knee Arthroplasty ePoster Presentation Kazuhisa Hatayama, MD, PhD, JAPAN Masanori Terauchi, MD, JAPAN Shingo Kurihara, MD, JAPAN Satoshi Nonaka, MD, JAPAN Hibiki Kakiage, MD, JAPAN
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
Long-Term Results of Per-Operative Knee Arthroscopy in Confirming Suitability for Unicompartmental Arthroplasty ePoster Presentation James Gill, MB BChir, BSc, FRCS, UNITED KINGDOM McMeniman J Peter, AUSTRALIA Timothy John Mcmeniman, MBBS(Med)/MBBS, FRACS FA(Orth)A, AUSTRALIA Daniel Johnson Brimm, BSc, MD, AUSTRALIA Peter T. Myers, AM, MBBS, FRACS, FAOrthA, AUSTRALIA
Differences In Pain, Sleep Status And Functional Recovery Between TKA And UKA ePoster Presentation Takeo Mammoto, MD, JAPAN
Advanced Active Robotic Technology for Total Knee Arthroplasty: A Learning Curve of Operative Time and Alignment Accuracy ePoster Presentation Yong-Beom Park, MD, PhD, KOREA, REPUBLIC OF Young-Bong Ko, MD, KOREA, REPUBLIC OF Dong-Hoon Lee, MD, KOREA, REPUBLIC OF Hyun-Chul Nam, MD, KOREA, REPUBLIC OF Seong-Hwan Kim, MD,Ph.D, MStat, KOREA, REPUBLIC OF
Participation of Physical Activity Following Knee Arthroplasty: A Meta-Analysis ePoster Presentation Ahmed A Magan, BM BSc (Hons) MRCS (Eng) FRCS (Eng) Trauma & Orth, UNITED KINGDOM Babar Kayani, BSc (HONS), MBBS, MRCS (Eng), UNITED KINGDOM Warran Wignadasan, MBBS, BSc (Hons), MRCS, UNITED KINGDOM Dia Eldean Giebaly, MBChB, MSc, FRCS, EMBA, UNITED KINGDOM Flaminia Ronca, PHD, UNITED KINGDOM Fares S. Haddad, MCh(Orth), BSc, FRCS(Orth), UNITED KINGDOM
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
How to Measure Physical Function in Clinical Trials on Patients Undergoing Total or Partial Knee Arthroplasty? A Systematic Review ePoster Presentation Marco Adriani, MD, ITALY Roland Becker, MD, PhD, Prof., GERMANY Aleksandra Krolikowska, PhD, Prof., POLAND Krzysztof Lachowski, MD, GERMANY Robert Prill, PhD, GERMANY
Patella in Total Knee Replacement: Patellar Resurfacing has Better Outcomes than Lateral Facetectomy at One Year Follow-Up ePoster Presentation Tomas Alfredo Esteves, MD, ARGENTINA Matias Novillo, MD, ARGENTINA Tomas Nicolino, MD, ARGENTINA Matias Costa-Paz, MD, PhD, ARGENTINA Lisandro Carbó, MD, ARGENTINA Julian Costantini, MD, ARGENTINA
Novel Technique For Surgeon-Placed Nerve Block And Continuous Nerve Block In Total Knee Arthroplasty. A Cadaveric Study ePoster Presentation Daniel E Matthews, MD, FAAOS, UNITED STATES
Antibiotic-Loaded Bone Cement with Colistin at Erythromycin Do Not Decrease Chronic TKA Pji at a Long-Term ePoster Presentation Daniel Pérez-Prieto, MD, SPAIN Albert Fontanellas, MD, SPAIN Pedro Hinarejos, MD, PhD, SPAIN Juan Francisco Sanchez-Soler, MD, PhD, SPAIN Raúl Torres-Claramunt, PhD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN
Use of Tibial Stem for Patients with Morbid Obesity in Total Knee Arthroplasty ePoster Presentation José Eduardo Flores Naranjo, MD, MEXICO Adrian Aziz Cortes De La Fuente, MD, MEXICO Octavio Martinez Montiel, MD, MEXICO Fernando Martinez Zuñiga, MD, MEXICO

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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

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Results

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