title: Local bone quality affects the outcome of prosthetic total knee arthroplasty.
abstract: Osteoporosis and osteoarthritis commonly coexist in the elderly. In patients undergoing prosthetic total knee arthroplasty (TKA), the bone quality around the knee joint may affect the safety of prosthetic implantation and consequently satisfaction with the surgical outcome. We recruited 50 postmenopausal women undergoing TKA for primary osteoarthritis; 43 completed the study protocol. The bone quality parameters of the operated knee, including bone mineral density assessed using dual-energy X-ray absorptiometry and microarchitecture variables assessed using micro-computed tomography, were determined. Surgical outcomes were assessed according to immediate (<1 week) postoperative pain quantified using the visual analog scale and knee function quantified using the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 2 and 6 months postoperatively. The influence of bone quality parameters on surgical outcomes was analyzed using simple and multiple regression analyses. Volumetric bone mineral density (R(2)  = 0.187-0.234, p < 0.01), the structural model index (R(2)  = 0.103-0.181, p < 0.05), and trabecular separation (R(2)  = 0.289-0.424, p < 0.05) were significantly associated with postoperative pain and improvement according to the KOOS. In conclusion, local bone quality, including mineral content and microarchitecture, affects the surgical outcome of TKA.
authors.affiliation: Department of Orthopaedic Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
authors.forename: Chuan-Ching
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ching-Chuan
authors.initials: CC
authors.lastname: Jiang
authors.affiliation: Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chang-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.affiliation: Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chia-Jung
authors.initials: CJ
authors.lastname: Tsai
authors.affiliation: Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hongsen
authors.initials: H
authors.lastname: Chiang
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D015519:Bone Density; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging; D007720:Knee Prosthesis; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery*; D015663:Osteoporosis, Postmenopausal / Q000150:complications*; D010149:Postoperative Pain / Q000453:epidemiology; D011446:Prospective Studies; D011859:Radiography; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
keywords: bone mineral density; implants; micro-computed tomography; osteoarthritis; osteoporosis