Measurement of Bone Density Around Total Knee Arthroplasty Using Fan-Beam Dual Energy X-ray Absorptiometry

Soininvaara, Tarja; Kröger, Heikki; Jurvelin, Jukka S.; Miettinen, Hannu; Suomalainen, O; Alhava, Esko

doi:10.1007/s002230001111

Cited by 45 publications

(34 citation statements)

References 19 publications

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“…BMD is an important measure of bone strength and quality [3]. The results of many studies confirm that DEXA scanning is reliable for the evaluation of bone mass around prosthetic implants [16] to precisely measure small bone mineral changes around TKA; it makes it possible to follow bone remodelling, and it may provide a feasible method for monitoring the implant during follow-up [13].…”

Section: Discussionmentioning

confidence: 98%

“…Lee et al [5] demonstrated in experimental studies that there are large differences in stability depending on the type of fixation. Changes in bone density must exceed over 50% in order to be recognisable on a standard X-ray [13]. Bone quality is important for the success of joint prostheses implantation, and the assessment of bone density after TKA with dual X-ray absorptiometry (DEXA) may be useful for monitoring implant stability [16].…”

Section: Introductionmentioning

confidence: 99%

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Influence of the tibial stem design on bone density after cemented total knee arthroplasty: a prospective seven-year follow-up study

Hernández-Vaquero

García-Sandoval

Fernández-Carreira

et al. 2006

International Orthopaedics (SICO

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We prospectively measured the changes in bone mineral density (BMD) in the proximal tibia of 20 total knee arthroplasties, ten with cruciform stems and ten with cylindrical stems. The measurements were made one, four and seven years after surgery. We observed a uniform density decrease in three regions of interest from one to seven years of follow-up. Cylindrical stems showed an asymmetrical density decrease between the three regions of interest, with no change in the central region, a slight decrease in the lateral region, and large decrease in the medial region. Multivariate analysis with general linear model showed the stem type factor as statistically significant for medial region of interest (p=0.006). The cylindrical stem produces heterogeneous BMD changes under the tibial platform in knee arthroplasties, and this could be a potential risk factor for asymmetrical subsidence of this component. Résumé Nous avons de façon prospective mesuré les modifications de la densité minérale osseuse (BMD) au niveau de la partie proximale du tibia chez 20 patients ayant bénéficié d'une prothèse totale du genou, 10 avec une quille cruciforme et 10 avec une quille cylindrique. Les mesures ont été réalisées de 1.4 à 7 ans après l'intervention chirurgicale. Nous avons observé une diminution uniforme de la densité minérale osseuse dans trois zones, durant cette période de 1 à 7 ans de suivi. La quille cylindrique montre que la densité minérale osseuse diminue de façon asymé-trique dans ces 3 régions sans modification au niveau de la région centrale, avec une légère diminution de la région externe (latérale) et une diminution plus importante de la région interne (médiale). Une analyse de régression multi variable montre que le type de quille est l'élément le plus significatif au niveau de la région interne (p=0.006). La quille cylindrique étant un facteur statistiquement significatif et entraînant des modifications hétérogènes de la BMD, sous le plateau tibial. Ces modifications peuvent être un risque potentiel de migration du composant tibial.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Influence of the tibial stem design on bone density after cemented total knee arthroplasty: a prospective seven-year follow-up study

Hernández-Vaquero

García-Sandoval

Fernández-Carreira

et al. 2006

International Orthopaedics (SICO

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“…However, during longitudinal assessments, other sources of error would need to be considered. Repositioning the subjects' limbs from day to day [20][21][22][23] and significant changes in soft tissue (disuse atrophy of muscle) may contribute to error during longitudinal studies using DXA scans. Accordingly, an intervention that has a small effect (≈10%) may be very difficult to reliably measure at the distal femur and proximal tibia, once all sources of error using DXA are taken into account.…”

Section: Discussionmentioning

confidence: 99%

Bone Mineral Density After Spinal Cord Injury: A Reliable Method for Knee Measurement

Shields¹,

Schlechte²,

Dudley-Javoroski³

et al. 2005

Archives of Physical Medicine and Rehabilitation

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Objectives-To test the interrater reliability of a standardized method to analyze knee bone mineral density (BMD) using dual-energy x-ray absorptiometry (DXA); to compare spine, hip, and knee BMD of people with spinal cord injury (SCI) with able-bodied controls; and to determine the relation between hip BMD and knee BMD in SCI and able-bodied subjects. Design-Criterion standard and masked comparison. Setting-Primary care university hospital.Participants-A convenience sample of 11 subjects with complete SCI was age and sex matched with 11 able-bodied control subjects. Interventions-Not applicable.Main Outcome Measures-Four raters analyzed regions of interest according to operational definitions recently developed to standardize the analysis of BMD of the knee. Subjects with chronic SCI and matched controls underwent conventional DXA scans of the spine and hips and "less conventional" scans of the distal femurs and proximal tibias. The relation between hip and knee BMD was analyzed.Results-The knee measurements were highly reliable (femur intraclass correlation coefficient model 2,1 [ICC 2,1 ]=.98; tibia ICC 2,1 =.89). Subjects with SCI had lower BMD values than controls at all hip and knee sites (P<.05). Lumbar spine BMD did not differ between groups. Hip BMD was moderately predictive of distal femur BMD (R 2 =.67), but less correlated with the proximal tibia (R 2 =.38).Conclusions-Knee BMD can be reliably analyzed using DXA with this protocol. Subjects with SCI have diminished knee and hip BMD. Low hip BMD is associated with low distal femur BMD. KeywordsFractures; Osteoporosis; Paralysis; Rehabilitation; X-ray absorptiometry; dual energy No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. Osteoporosis is a severe and debilitating secondary complication of complete spinal cord injury (SCI). Bone mineral density (BMD) of the paralyzed extremities declines precipitously in the first 2 years after SCI, eventually reaching a level below fracture threshold. 1-4 Between 1% and 6% of people with SCI will sustain fractures in their paralyzed extremities. [5][6][7] Fractures are often caused by trivial insults to the limbs 5,7,8 that people with SCI frequently encounter during everyday mobility. NIH Public AccessThe main instrument used to measure BMD is dual-energy x-ray absorptiometry (DXA). In postmenopausal women, DXA-based BMD T scores are used to diagnose osteoporosis and the technique is valuable for monitoring longitudinal changes in bone density. The progression of osteoporosis after SCI has been described for the hip and lumbar spine. In general, hip BMD declines rapidly for the first several months, then declines more slowly until reaching equilibrium at 12 to 16 months postinjury. 1,2,4 Lumbar spine BMD generally does not decline and may even increase after SCI. 4,9 By far the most common sites for fracture after SCI are the distal femu...

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“…Dual-energy xray absorptiometry (DEXA) studies suggest proximal tibial BMD declines after TKA [1,5,9,12,17,[19][20][21]. However, it is not clear whether there are differences in BMD changes between cortical and cancellous bone.…”

Section: Introductionmentioning

confidence: 99%

Loss of Tibial Bone Density in Patients with Rotating- or Fixed-platform TKA

Munro

Pandit

Walker

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Little is known about tibial bone remodeling with TKA and its clinical relevance. We performed a randomized clinical trial to compare tibial bone density changes in cemented components with different bearing designs. Bone density changes were assessed using quantitative computed tomography (qCT)-assisted osteodensitometry. Twenty-eight rotating-platform and 26 fixed-platform cemented TKAs were included. The nonoperated contralateral side was used as a control. CT scans were performed postoperatively and 1 year and 2 years after the index operation. Cancellous bone density loss (up to 12.6% at 2 years) was observed in all proximal tibial regions in both cohorts. In contrast, we found lower cortical bone density loss (up to 3.6% at 2 years). We found no differences in bone loss between fixed-and rotating-platform implants. The decrease of cancellous bone density after TKA suggests stress transfer to the cortical bone.

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Measurement of Bone Density Around Total Knee Arthroplasty Using Fan-Beam Dual Energy X-ray Absorptiometry

Cited by 45 publications

References 19 publications

Influence of the tibial stem design on bone density after cemented total knee arthroplasty: a prospective seven-year follow-up study

Influence of the tibial stem design on bone density after cemented total knee arthroplasty: a prospective seven-year follow-up study

Bone Mineral Density After Spinal Cord Injury: A Reliable Method for Knee Measurement

Loss of Tibial Bone Density in Patients with Rotating- or Fixed-platform TKA

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