Bone Quality Assessment Before Total Hip Arthroplasty: The Role of Densitometry

TL;DR

This study shows that bone mineral density (BMD) measurements are more reliable than radiographic parameters for assessing bone quality before hip replacement surgery.

Contribution

The study demonstrates that BMD correlates better with intraoperative bone measurements than traditional radiographic indicators.

Findings

BMD significantly correlates with intraoperative femoral neck diameter and cortical bone thickness.

Radiographic parameters like CC ratio and CI show weaker correlations with intraoperative measurements.

BMD can be a more accurate tool for preoperative bone quality assessment in THA planning.

Abstract

Background

Total hip arthroplasty (THA) is effective in the treatment of hip osteoarthritis. Radiographic evaluation, standard in THA planning, is sufficient in examining hip anatomy, although it may not precisely assess bone quality. A routinely implemented method in bone quality assessment is densitometry. The technique allows for a measurement of bone mineral density (BMD).

Methodology

In the study, we included 26 participants who qualified for THA. All the patients were preoperatively examined with radiographs and densitometry of the affected hip. On the preoperative anteroposterior radiograph, we measured the canal-to-calcar isthmus ratio (CC ratio) and the cortical index (CI). Intraoperatively, during the THA procedure, we measured the thickness of the cortical bone and the diameter of the femoral neck in the line of neck resection.

Results

The examination with Pearson’s correlation coefficient revealed that BMD significantly positively correlates with the intraoperatively measured diameter of the femoral neck (r = 0.5, P = 0.009), and with the measured thickness of the cortical bone (r = 0.47, P = 0.015), CI significantly positively correlates with the intraoperatively measured diameter of the femoral neck (r = 0.6, P = 0.001), and with the CC ratio (r = 0.44, P = 0.024), the intraoperatively measured diameter of the femoral neck significantly positively correlates with the intraoperatively measured thickness of the cortical bone (r = 0.59, P = 0.001). All of the other correlations were not statistically significant.

Conclusions

BMD measurements can be used in THA planning as they positively correlate with intraoperative measurements. The radiological parameters (CC ratio and CI) may not be as precise in bone quality assessment.

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