Intraoperative physician assessment during total hip arthroplasty correlates with DXA parameters

Area of Science:

• Orthopedics
• Bone Health
• Surgical Assessment

Background:

• Intraoperative physician assessment (IPA) during total knee arthroplasty correlates with bone mineral density (BMD).
• Evaluating IPA's utility in total hip arthroplasty (THA) for quantitative bone status assessment is crucial.

Purpose of the Study:

• To evaluate intraoperative physician assessment (IPA) during total hip arthroplasty (THA) as a quantitative measure of bone status based on tactile assessment.
• To compare IPA scores with preoperative bone mineral density (BMD) and fracture risk assessments.

Main Methods:

• Retrospective analysis of 60 patients (64 hips) undergoing primary THA with recorded IPA and prior DXA.
• Surgeons used a 5-point scale for intraoperative bone quality assessment (IPA).
• IPA scores were compared with DXA BMD, T-score, 3D Shaper measurements, WHO classification, FRAX scores, Dorr classification, and cortical index.

Main Results:

• Strong correlation between IPA score and lowest T-score, WHO classification, and FRAX scores (r=±0.485-0.622, p<0.001).
• Moderate correlation between IPA score and total hip BMD and 3D Shaper measurements (r=±0.326-0.386, p<0.01).
• All patients with below-average IPA scores exhibited osteopenia or osteoporosis by DXA.

Conclusions:

• Intraoperative physician assessment (IPA) during THA is a valuable, simple tool for quantifying bone status via tactile feedback.
• IPA can identify patients needing skeletal health evaluation and guide intraoperative implant selection.
• IPA strongly correlates with bone density and fracture risk, informing surgical decisions and future bone health treatment.