Preoperative computer tomography scans can accurately evaluate tibial bone mineral density for selecting bone fixation in total knee arthroplasty
Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION/OBJECTIVE: The mechanical quality of bone at the proximal tibia is an important factor for the success of cementless total knee arthroplasty (TKA). The purpose of this study was to evaluate the relationship between preoperative bone mineral density (BMD) at the tibial resection level (tibial BMD) using computed tomography (CT) and intraoperative cancellous bone durability (ICBD) in TKA. METHODS: All consecutive cemented and cementless TKAs performed by a single surgeon between April 2024 and October 2024 were evaluated. All patients were examined preoperatively for tibial BMD via CT, hip BMD via dual-energy X-ray absorptiometry. A block of cancellous bone with a diameter of 10 mm and a height of 10 mm was harvested at the center of the tibia. The fixation method was selected intraoperatively according to the macroscopically evaluated bone quality. Using a pusher tension gauge and a metal measure, the force required to compress the harvested bone from 10 mm to 5 mm was measured and defined as ICBD. Pearson product-moment correlations were calculated to assess the relationships between tibial and hip BMD and ICBD. RESULTS: . There was a very strong correlation between tibial BMD and ICBD (r = 0.88, P < 0.01) and a strong correlation between hip BMD and ICBD(r = 0.62, P < 0.01). CONCLUSION: This study is the first report to focus on the relationships between CT-based tibial BMD and the actual bone quality of the proximal tibia . Assessment of bone quality via CT is accurate, relatively simple, and potentially useful for determining whether cementless fixation in TKA is indicated. For cementless fixation, 46.4 HA/cm3 and 55.7 N were found as tibial BMD and ICBD cut-off values. LEVEL OF EVIDENCE: Retrospective cohort study, Level Ⅳ.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,000
OpenAlex ID: W4410083393