Evidence map›Paper›PMID 40202590›Full record

ArticleArchives of osteoporosis2025

Is surgeon assessed bone quality during total knee arthroplasty a valid tool to diagnose osteoporosis?

Adit R Maniar, Akshay Nayak, Arpit Bavaskar, Vishal Raina, Ashwini Khokhar, Rajesh N Maniar

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Article in Archives of osteoporosis, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Adit R ManiarLilavati Hospital and Research Centre, Mumbai, India.ORCID 0000-0003-4683-8143
Akshay NayakPranav Hospital, Gandhi Maidan, Near Handady Grama Panchayat, Bramavara, Handady, Karnataka, 576213, India.ORCID 0000-0002-9339-1615
Arpit BavaskarSuvidhi Multispeciality Hospital, Market Yard, Near Bus Stand, BajartalChandwad, Maharashtra, 423101, India.ORCID 0000-0001-8393-1924
Vishal RainaEden Critical Hospital, 116, next to Eden Hospital, Opp. Hometel Hotel, Industrial Area Phase 2, Industrial Area Phase I, Chandigarh, 160002, India.ORCID 0000-0002-7006-1023
Ashwini KhokharPandit Madan Mohan Malviya Hospital, Govandi, Mumbai, 400071, India.ORCID 0009-0002-6117-906X
Rajesh N ManiarLilavati Hospital and Research Centre, Mumbai, India. drmaniar@jointspeciality.com.ORCID 0000-0002-8808-9155

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Osteoporosis continues to have a high prevalence amongst people undergoing total knee arthroplasty (TKA). The surgeon assessed intraoperative bone quality using a visual analogue scale has a strong correlation with bone mineral density. Surgeon assessment of bone quality has a high specificity(100%) and positive predictive value(100%) in diagnosing osteoporosis and osteopenia.

backgroundPatients undergoing TKA have a high prevalence of osteoporosis. Our aim is to study (a) the correlation of intraoperative surgeon assessed bone quality with bone mineral density(BMD) as measured by dual-energy x-ray absorptiometry(DEXA) and (b) the diagnostic strength of intraoperative surgeon assessment of bone quality in diagnosing osteoporosis and osteopenia, in patients undergoing TKA.

methodsWe prospectively recruited 31 patients undergoing TKA. Patients were classified into normal, osteopenia or osteoporosis based on preoperative DEXA. Intraoperatively, the senior surgeon by visual and tactile assessment, graded the bone quality(BQ) using a visual analogue scale(VAS) from 0 to 10, with 10 being the strongest bone. Using the VAS score, we classified patients as normal(≥ 8), osteopenia(5-7) and osteoporosis(≤ 4).

resultsThe Spearman's rho correlation between BMD and VAS was 0.954.(p < 0.001). VAS < 8 to diagnose osteopenia and osteoporosis had a sensitivity of 70.83%, specificity of 100%, positive predictive value of 100% and diagnostic accuracy of 77.42%(p = 0.001). VAS ≤ 4 to diagnose osteoporosis had a sensitivity of 71.43%, specificity of 100%, positive predictive value of 100% and diagnostic accuracy of 93.55%(p < 0.001).

conclusionThe surgeon assessed intraoperative bone quality using a VAS during TKA has a strong correlation with the gold standard BMD as measured by DEXA scan. VAS ≤ 4 can help diagnose osteoporosis, allowing surgeons to augment implant fixation with stem and cement as well as guide osteoporosis treatment postoperatively. VAS < 8 can identify osteopenic or osteoporotic bone, thus allowing the surgeon to better identify weaker bone and help titrate implant choice.

Indexed as

Arthroplasty, Replacement, KneeBone DensityOsteoporosisAbsorptiometry, PhotonAgedAged, 80 and overBone Diseases, MetabolicFemaleHumansMaleMiddle AgedProspective StudiesBone mineral densityBone qualityOsteoporosisSurgeon assessedTotal knee arthroplasty

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.