Bone quality. Roentgenographic versus histologic assessment of hip bone structure

Bone quality is an accepted criterion for determining fixation options for total hip arthroplasty (THA). Eighty patients with 95 uncemented THAs were evaluated by comparing preoperative roentgenographic assessment with histologic evaluation of bone biopsy specimens obtained from the ipsilateral iliac crest. Roentgenographic analysis of bone quality was performed using the Singh and Engh indices. Histologic evaluation employed a quantitative analysis of static and dynamic parameters of bone turnover on undecalcified sections. Extensive statistical analysis comparing roentgenographic with histologic parameters of bone quality showed: (1) no relationship of the two roentgenographic indices to trabecular bone volume and most other histologic parameters and (2) a high incidence of bone abnormalities. Bone quality is an imprecise term and is inadequately measured by these roentgenographic indices. Histologic measurement offers a more precise means of analyzing the relationship of the bone environment to the performance of the THA.