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Intraoperative physician assessment of bone: correlation to bone mineral density

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Abstract

Summary

This study evaluated the intraoperative physician assessment (IPA) of bone status at time of total knee arthroplasty. IPA was highly correlated with distal femur and overall bone mineral density. When IPA identifies poor bone status, formal bone health assessment is indicated.

Purpose

Intuitively, intraoperative physician assessment (IPA) would be an excellent measure of bone status gained through haptic feedback during bone preparation. However, no studies have evaluated the orthopedic surgeon’s ability to do so. This study’s purpose, in patients undergoing total knee arthroplasty (TKA), was to relate IPA with (1) the lowest bone mineral density (BMD) T-score at routine clinical sites; and (2) with distal femur BMD.

Methods

Seventy patients undergoing TKA by 3 surgeons received pre-operative DXA. Intraoperatively, bone quality was assessed on a 5-point scale (1 excellent to 5 poor) based on tactile feedback to preparation. Demographic data, DXA results, and IPA score between surgeons were compared by factorial ANOVA. Lowest T-score and distal femur BMD were associated with IPA using Spearman’s correlation.

Results

The mean (SD) age and BMI were 65.8 (7.6) years and 31.4 (5.1) kg/m2, respectively. Patient demographic data, BMD, and IPA (mean [SD] = 2.74 [1.2]) did not differ between surgeons. IPA correlated with the lowest T-score (R = 0.511) and distal femur BMD (R = 0.603–0.661). Based on the lowest T-score, no osteoporotic patients had an IPA above average, and none with normal BMD was classified as having poor bone.

Conclusions

IPA is highly correlated with local (distal femur) and overall BMD. This study supports the International Society for Clinical Densitometry position that surgeon concern regarding bone quality should lead to bone health assessment. As IPA is comparable between surgeons, it is logical this can be widely applied by experienced orthopedic surgeons. Future studies evaluating IPA at other anatomic sites are indicated.

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Authors and Affiliations

  1. Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 4602 Eastpark Blvd, MCAC06, Madison, WI, 53718, USA

    Brian Nickel, Richard Illgen, David Hennessy, Scott Hetzel & Paul A. Anderson

  2. Osteoporosis Clinical Research Program, University of Wisconsin-Madison, Madison, WI, USA

    Diane Krueger, Gretta Borchardt, Lucas Andersen & Neil Binkley

Authors
  1. Brian Nickel
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  2. Diane Krueger
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  3. Gretta Borchardt
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  4. Lucas Andersen
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  5. Richard Illgen
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  6. David Hennessy
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  7. Scott Hetzel
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  8. Neil Binkley
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  9. Paul A. Anderson
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Correspondence to Brian Nickel.

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All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Nickel, B., Krueger, D., Borchardt, G. et al. Intraoperative physician assessment of bone: correlation to bone mineral density. Osteoporos Int 34, 1093–1099 (2023). https://doi.org/10.1007/s00198-023-06729-3

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  • DOI: https://doi.org/10.1007/s00198-023-06729-3

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