Femur and Tibia BMD Measurement in Elective Total Knee Arthroplasty Candidates |
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| Institution: | 1. Osteoporosis Clinical Research Program, University of Wisconsin-Madison, Madison, WI, USA;2. Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA;1. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia;2. Medical School, University of Western Australia, Crawley, Western Australia, Australia;3. School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia;4. Busselton Population Medical Research Institute, Busselton, Western Australia, Australia;5. Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia;1. Weill Cornell Medicine in Qatar, Doha, Qatar;2. Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, USA;3. Healthcare Research Institute, Hospital for Special Surgery, New York, NY 10021, USA;4. Rheumatology, Hospital for Special Surgery, New York, NY, USA;1. Laboratory for Research of the Musculoskeletal System “Th. Garofalidis”, Medical School, National and Kapodistrian University of Athens, KAT General Hospital of Athens, Athens, Greece;2. Clinical Biochemistry Department, KAT General Hospital of Athens, Athens, Greece;3. 5th Orthopaedic Department, HYGEIA Hospital, Athens, Greece;1. Center of Prevention and Rehabilitation, UniReha, Cologne, Germany, University of Cologne, Medical Faculty and University Hospital Cologne, Germany;2. Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany;3. Department of Psychiatry, Psychosomatics and Psychotherapy for Children and Adolescents, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany;4. Department of Neuropediatrics, University Children''s Hospital, Klinikum Oldenburg, Oldenburg, Germany;1. Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children''s Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israe;2. The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv;3. Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israe;4. Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, The Edmond and Lily Safra Children''s Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel |
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| Abstract: | Distal femur BMD declines ～20% following total knee arthroplasty (TKA) potentially leading to adverse outcomes. BMD knowledge before and following TKA might allow interventions to optimize outcomes. We hypothesized that distal femur and proximal tibial BMD could be reproducibly measured with existing DXA technology. Elective TKA candidates were enrolled and standard clinical DXA plus bilateral PA and lateral knee scans acquired. Manual regions of interest (ROIs) were placed at distal femur and proximal tibia sites based on required TKA machining and periprosthetic fracture location. Intra- and inter-rater BMD reliability was assessed by intra-class correlation (ICC). Custom and standard proximal femur BMD were correlated by linear regression and paired t test evaluated BMD differences between planned surgical and contralateral side. One hundred subjects (68F/32M), mean (SD) age and BMI of 67.2 (7.7) yr and 30.8 (4.8) kg/m2 were enrolled. Lowest clinical BMD T-score was < -1.0 in 65% and ≤ -2.5 in 16%; 34 had prior fracture. BMD reproducibility at all custom ROIs was excellent; ICC > 0.96. Mean BMD at custom ROIs ranged from 0.903 to 1.346 g/cm2 in the PA projection and 0.891 to 1.429 g/cm2 in the lateral. Lower BMD values were observed at the proximal tibia, while the higher measurements were at the femur condyle. Custom knee ROI BMD was highly correlated (p < 0.0001) with total and femur neck with better correlation at ROIs adjacent to the joint (R2 = 0.62–0.67, 0.49–0.55 respectively). In those without prior TKA (n = 76), mean BMD was lower (2.8%–6.6%; p < 0.05) in the planned surgical leg at all custom ROIs except the PA tibial regions. Individual variability was present with 82% having a custom ROI with lower BMD (up to 53%) in the planned operative leg. Distal femur and proximal tibial BMD can be measured using custom ROIs with good reproducibility. Suboptimal bone status is common in TKA candidates and distal femur/proximal tibia BMD is often lower on the planned operative side. Routine distal femur/proximal tibial BMD measurement might assist pre-operative interventions, surgical decision-making, subsequent care and outcomes. Studies to evaluate these possibilities are indicated. |
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