Bone Density Measurement with IMAGE J-software in Primary Uncemented Total Hip Replacement.

Abstract

Background: The success of cementless total hip arthroplasty (THA) relies on its primary mechanical stability and secondary biological fixation, which can be assessed by specific exams like dual-energy x-ray absorptiometry (DEXA) or computed tomography (CT). We evaluated the bone adaptation of a cementless primary THA using a validated image analysis tool and plain radiographs.

Material and methods: Patients who received a cementless THA from September 2020 to July 2022 were included in the study. Clinical scores and X-rays were collected prospectively. Relative bone density (RBD) was calculated for each patient, using Rossler validated method with Image-J software, to assess bone density changes after THA.

Results: 155 patients at a mean age of 56.4 years (range 31-84) were followed up for 38.5 months. Harris Hip Score was 92.2 at the latest follow-up. Radiographically, all the cups were positioned in the Lewinnek safe zone. Five cups showed non-progressive radiolucent lines. RBD showed a significant decrease in Gruen zone 1, while the percentage difference in the other zones ranged from -9% to +4%. In the cohort, there were 2 intraoperative fractures treated with cerclage wires. One patient had a superficial infection, and another one had a deep infection.

Conclusions: 1. ImageJ stands out as a robust tool for the quantitative assessment of osteointegration in uncemented hip implants. 2. Its ability to analyse regular x-ray data with precision supports better clinical outcomes. 3. By incorporating ImageJ into routine assessments, orthopaedic surgeons can achieve a more accurate understanding of bone-implant interactions, leading to optimized patient care and improved implant survival rates analysis. 4. The consideration of cost and time efficiency further underscores the value of ImageJ in clinical practice, making it a valuable asset.