Radiographic Prediction of Intraoperative Bone Loss in Knee Arthroplasty Revision

A key challenge for orthopaedic surgeons performing revision total knee arthroplasty is the management of bone loss. The goal of our study was to test the validity of predicting bone loss from preoperative radiographs using two commonly utilized bone loss assessments: the Anderson Orthopaedic Research Institute and University of Pennsylvania systems and secondarily to assess the frequency and severity of bone loss in a prospective study of total knee arthroplasty revisions. Ninety-eight total knee arthroplasty revision patients were assessed and bone loss was detected in 76 (77.6%) patients preoperatively and intraoperatively. The validity of both systems was established. Agreement between preoperative and intraoperative Anderson Orthopaedic Research Institute classification was fair for the femur and good for the tibia. All University of Pennsylvania preoperative measures were correlated with intraoperative measures. Establishing valid and reliable preoperative systems of measuring bone loss facilitates planning of total knee arthroplasty revision and rehabilitation and meaningful comparisons between different series of patients and treatment protocols.

Level of Evidence: Diagnostic study, level I (prospective testing of previously developed diagnostic criteria on consecutive patients [with universally applied reference “gold” standard]). See Author Guidelines for a complete description of levels of evidence.