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Intraoperative Bone-Quality Assessments Are Reliable Compared with Opportunistic CT-Based Hounsfield Unit
Jennifer Lewis1, Anthony Christiano1, Mary Kate Erdman1
1Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, Illinois.
The Journal of Bone and Joint Surgery. American Volume
|April 10, 2026
Summary
Orthopaedic surgeons can accurately assess bone density during surgery, correlating well with CT scans. This reliable intraoperative evaluation aids decision-making for bone health interventions.
Area of Science:
- Orthopaedic Surgery
- Bone Densitometry
- Radiology
Background:
- Intraoperative assessment of bone quality by surgeons is common but its accuracy is unknown.
- Accurate bone density evaluation is crucial for treatment decisions in orthopaedic conditions.
Purpose of the Study:
- To determine the correlation between orthopaedic surgeons' intraoperative assessment of bone quality and validated measures.
- To evaluate the reliability of surgeon assessments in identifying abnormal bone density.
Main Methods:
- Prospective cross-sectional study involving adult patients undergoing orthopaedic surgery.
- Surgeons provided intraoperative bone quality assessments (Likert scale) blinded to objective measures.
- Computed tomography (CT) scans were used to measure Hounsfield units (HUs) for objective bone quality evaluation.
Main Results:
- A positive linear relationship (r = 0.66; p < 0.0001) was found between Hounsfield units and surgeon assessments.
- Surgeon assessments demonstrated 84% sensitivity and 97% specificity in identifying abnormal bone quality.
- The correlation was consistent across various surgical anatomic sites.
Conclusions:
- Orthopaedic surgeons can reliably detect abnormal bone quality during intraoperative assessments.
- Intraoperative bone quality assessment provides actionable feedback without extra cost or radiation.
- This evaluation can inform surgical decisions and identify opportunities for bone health interventions.
