Is surgeon assessed bone quality during total knee arthroplasty a valid tool to diagnose osteoporosis?

IF 3.1 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Archives of Osteoporosis Pub Date : 2025-04-09 DOI:10.1007/s11657-025-01531-6

Adit R. Maniar, Akshay Nayak, Arpit Bavaskar, Vishal Raina, Ashwini Khokhar, Rajesh N. Maniar

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引用次数: 0

Abstract

Summary

Osteoporosis continues to have a high prevalence amongst people undergoing total knee arthroplasty (TKA). The surgeon assessed intraoperative bone quality using a visual analogue scale has a strong correlation with bone mineral density. Surgeon assessment of bone quality has a high specificity(100%) and positive predictive value(100%) in diagnosing osteoporosis and osteopenia.

Background

Patients undergoing TKA have a high prevalence of osteoporosis. Our aim is to study (a) the correlation of intraoperative surgeon assessed bone quality with bone mineral density(BMD) as measured by dual‐energy x-ray absorptiometry(DEXA) and (b) the diagnostic strength of intraoperative surgeon assessment of bone quality in diagnosing osteoporosis and osteopenia, in patients undergoing TKA.

Methods

We prospectively recruited 31 patients undergoing TKA. Patients were classified into normal, osteopenia or osteoporosis based on preoperative DEXA. Intraoperatively, the senior surgeon by visual and tactile assessment, graded the bone quality(BQ) using a visual analogue scale(VAS) from 0 to 10, with 10 being the strongest bone. Using the VAS score, we classified patients as normal(≥ 8), osteopenia(5–7) and osteoporosis(≤ 4).

Results

The Spearman’s rho correlation between BMD and VAS was 0.954.(p < 0.001). VAS < 8 to diagnose osteopenia and osteoporosis had a sensitivity of 70.83%, specificity of 100%, positive predictive value of 100% and diagnostic accuracy of 77.42%(p = 0.001). VAS ≤ 4 to diagnose osteoporosis had a sensitivity of 71.43%, specificity of 100%, positive predictive value of 100% and diagnostic accuracy of 93.55%(p < 0.001).

Conclusion

The surgeon assessed intraoperative bone quality using a VAS during TKA has a strong correlation with the gold standard BMD as measured by DEXA scan. VAS ≤ 4 can help diagnose osteoporosis, allowing surgeons to augment implant fixation with stem and cement as well as guide osteoporosis treatment postoperatively. VAS < 8 can identify osteopenic or osteoporotic bone, thus allowing the surgeon to better identify weaker bone and help titrate implant choice.

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外科医生在全膝关节置换术中评估骨质量是诊断骨质疏松症的有效工具吗？

骨质疏松症在接受全膝关节置换术（TKA）的人群中仍然有很高的患病率。外科医生使用视觉模拟量表评估术中骨质量与骨密度有很强的相关性。外科医生评估骨质量在诊断骨质疏松和骨质减少方面具有高特异性（100%）和阳性预测价值（100%）。背景：接受全髋关节置换术的患者骨质疏松的患病率很高。我们的目的是研究(a)术中外科医生评估的骨质量与双能x线骨密度（DEXA）测量的骨矿物质密度（BMD）的相关性，以及(b)手术中外科医生评估的骨质量在诊断骨质疏松症和骨质减少症中的诊断强度。方法前瞻性招募31例TKA患者。根据术前DEXA将患者分为正常、骨质减少和骨质疏松。术中，资深外科医生通过视觉和触觉评估，使用视觉模拟评分（VAS）对骨质量（BQ）进行评分，从0到10分，10分为最强骨。根据VAS评分，我们将患者分为正常（≥8）、骨质减少（5-7）和骨质疏松（≤4）。结果BMD与VAS的Spearman相关系数为0.954 （p < 0.001）。VAS <； 8诊断骨质减少和骨质疏松的敏感性为70.83%，特异性为100%，阳性预测值为100%，诊断准确率为77.42%（p = 0.001）。VAS≤4诊断骨质疏松的敏感性为71.43%，特异性为100%，阳性预测值为100%，诊断准确率为93.55%（p < 0.001）。结论外科医生在TKA期间使用VAS评估术中骨质量与DEXA扫描测量的金标准骨密度有很强的相关性。VAS≤4有助于骨质疏松症的诊断，可帮助外科医生加强种植体的茎、骨水泥固定，并指导术后骨质疏松症的治疗。VAS <； 8可以识别骨质减少或骨质疏松的骨，从而使外科医生更好地识别较弱的骨，并帮助滴定种植体的选择。

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来源期刊

Archives of Osteoporosis ENDOCRINOLOGY & METABOLISMORTHOPEDICS -ORTHOPEDICS

CiteScore

5.50

自引率

10.00%

发文量

133

期刊介绍： Archives of Osteoporosis is an international multidisciplinary journal which is a joint initiative of the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA. The journal will highlight the specificities of different regions around the world concerning epidemiology, reference values for bone density and bone metabolism, as well as clinical aspects of osteoporosis and other bone diseases.