Use of Morphometry to Quantify Osteolysis after Total Hip Arthroplasty

Abstract

Background Progressive osteolysis threatens the longevity of hip arthroplasties and radiographic review is recommended. Measurement of osteolytic lesions in a clinical setting has not been achieved easily in the past. Other radiologic investigations provide accurate information but cost and risk to the patient prohibit their use in routine review. Questions/purposes We developed a simple, reliable tool to be used in hip arthroplasty review to quantify osteolytic changes seen on plain film radiographs. Methods A morphometric grid was developed and tested on simulated and actual osteolytic lesions. Four health professionals measured lesions on each of two occasions. Intraclass correlation coefficients (ICC) for interobserver and intraobserver reliabilities were calculated and BlandAltman plots were constructed for graphic analysis. ResultsThe ICCs for interobserver reliability on the simulated and actual osteolytic lesions were in the range 0.90 to 0.96. The values for intraobserver (test-retest) reliability were 0.97 to 0.98. The Bland-Altman plots confirmed agreement and in each case, proximity of the mean to zero indicated no significant bias. Conclusions The data show a morphometric grid is reliable for measuring osteolytic changes after hip arthroplasty. Clinical Relevance This tool has potential to improve monitoring processes for hip arthroplasty and to be useful in future research studies. Additional work is needed to test for validity and clinical importance of the measurements obtained.

Alumina Heads Minimize Wear and Femoral Osteolysis Progression After Isolated Simple Acetabular Revision

“…To calculate the area of the osteolysis, we identified lesions and traced them on each axial cut using the Photoshop 1 semiautomated edge detection module. Intraclass correlation coefficients (ICCs) for interobserver and intraobserver reliabilities were calculated to quantify osteolytic changes seen on plain film radiographs by Smith et al [20]. The ICCs for interobserver reliability on the simulated and actual osteolytic lesions ranged from 0.90 to 0.96; the values for intraobserver (test-retest) reliability ranged from 0.97 to 0.98.…”

Empirical Support for Radiographic Review: A Follow-Up Study of Total Hip Arthroplasty

“…Osteolysis was defined as a new or expanding radiolucent area in which no trabeculae were visible compared to adjacent bone (26, 27). Radiolucencies greater than 2 mm in width were noted as osteolysis (28) and the area of an osteolytic lesion was recorded by superimposing a simple morphometric grid designed for this purpose (29). Radiographic assessment of the femoral component included stem inclination, subsidence, calcar rounding and resorption (26, 30, 31).…”

Review of periprosthetic osteolysis in total joint arthroplasty: An emphasis on host factors and future directions

“…69 Aside from radiographic imaging studies that seek to qualify and quantify the presence of aseptic loosening via image analysis, other viable avenues have emerged that may prove of some benefit when attempting to evaluate the progression of debrisinduced bone resorption such as dual-energy X-ray absorptiometry (DEXA), morphometric grid analysis of lytic lesion advancement, and radiographic texture analysis (RTA) of trabecular bone patterns. [70][71][72][73] Furthermore, adequate biologic markers of osteolysis must be identified to evaluate the condition's progression to supplement where imaging evaluation has fallen short. One such possibility is the use of peripheral blood levels of CD14 þ CD16 þ monocytes which have proven to be sensitive markers of aseptic loosening.…”