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

Adit Maniar, MBBS, MS Orthopaedics, DNB Orthopaedics
CANADA

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

Adit Maniar, MBBS, MS Orthopaedics, DNB Orthopaedics, CANADA 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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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
Subtalar Joint Compensation using Full-length Standing Lower Extremity Anteroposterior Radiograph after Total Knee Arthroplasty for Varus Osteoarthritis in Nara Medical University Hospital with 2-year Follow-up ePoster Presentation Jerre Co De Guzman, MD, PHILIPPINES Munehiro Ogawa, MD, PhD, JAPAN Yusuke Ozaki, MD, JAPAN Yasuhito Tanaka, Prof., JAPAN Yuki Nishimura, MD, JAPAN Maria Elizabeth Mercado, MD, MAS, PHILIPPINES
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
Patellofemoral Arthroplasty In Community Programs: Case Series of 425 Patients ePoster Presentation Alexander P. Sah, MD, UNITED STATES
Evaluation of The Safety And Efficacy of The Fully Automated Active Robotic System In Robotic Assisted Total Knee Arthroplasty ePoster Presentation Sanjay B. Londhe, MS, FRCS, FRCSI, MCh, INDIA Santosh Chandrashekar Shetty, MS, INDIA Ashit Hasmukhbhai Shah, FRCS Orth, M ChOrth, M S Orth, D N B Orth, INDIA Niraj Vora, MS,MRCS, INDIA Vijay Shetty, MD, MSc, FRCSC, INDIA Rakesh Nair, MS, INDIA Clevio Joao Baptista Desouza, MS , INDIA Farheen Khan, B.Tech, INDIA
Short-Term Clinical Outcome Of Functionally Aligned Robotic-Assisted BCS TKA is Better Than That Of Mechanically Aligned Navigation-Assisted BCS TKA ePoster Presentation Daisuke Hamada, MD, PhD, JAPAN Keizo Wada, MD, JAPAN Yasuaki Tamaki, MD, JAPAN Yasuyuki Omichi, MD, JAPAN Tomohiro Goto, MD, PhD, JAPAN Koichi Sairyo, MD, PhD, JAPAN
Accuracy of Advanced Active Robotic Technology for Total Knee Arthroplasty: A Cadaveric Study ePoster Presentation Yong-Beom Park, MD, PhD, KOREA, REPUBLIC OF Seong-Hwan Kim, MD,Ph.D, MStat, KOREA, REPUBLIC OF Young-Bong Ko, MD, KOREA, REPUBLIC OF
Relationship Between The Femoral And Tibial Component Positions And Postoperative Knee Range Of Motion After Posterior-Stabilized Total Knee Arthroplasty ePoster Presentation Mitsuru Hanada, MD, PhD, JAPAN Yukihiro Matsuyama, MD, PhD, Prof., JAPAN
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
Patient Satisfaction and Functional outcomes in a Latin American cohort: Comparative Study Between Conventional Technique vs. Robotic Arm Assistance. ePoster Presentation Rafael Calvo, MD, CHILE Maria Loreto Figueroa Berrios, MD, CHILE Rodrigo Guiloff, MD, Prof, CHILE Zoy Anastasiadis, MD, CHILE David H. Figueroa, MD, CHILE
Detection Loosening of Total Knee Arthroplasty Implant from Plain Radiograph Using Machine Learning Algorithm ePoster Presentation Man-Soo Kim, MD, PhD, KOREA, REPUBLIC OF Dongho Kwak, MD, KOREA, REPUBLIC OF Sungcheol Yang, MD, KOREA, REPUBLIC OF Hyukjin Jang, MD, KOREA, REPUBLIC OF Ryu Kyoung Cho, MD, KOREA, REPUBLIC OF Yong In, MD, PhD, KOREA, REPUBLIC OF
Palliative Arthroscopic Debridement with Continuous Irrigation for the Infection TKA of High Mortality Risk Patients ePoster Presentation Yoon Sang Jeon, MD, KOREA, REPUBLIC OF Sung-Sahn Lee, MD., PhD., KOREA, REPUBLIC OF Yoon Cheol Nam, MD, KOREA, REPUBLIC OF Dong Jin Ryu, MD, PhD., KOREA, REPUBLIC OF

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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