Is poor bone quality associated with pain after total knee arthroplasty (TKA)?
Location
Medical Education Building, LSUHSC-NO
Presentation Date
10-10-2019 10:00 AM
End Date
10-10-2019 12:00 PM
Description
INTRODUCTION: Osteoporosis is drastically underdiagnosed in patients who undergo TKA for osteoarthritis [1]. Previous research by our group found in a cohort of 204 Louisiana patients undergoing TKA who also met the United States Preventative Services Task Force (USPSTF) criteria for bone mineral density screening, only 20% had actually been screened [2]. While there are obvious consequences of underdiagnosis – increased risk of fracture or a change in surgical procedure [3,4], current guidelines from the American Academy of Orthopaedic Surgeons (AAOS) do not offer a recommendation regarding BMD screening for TKA patients [5]. Because screening for BMD is under-utilized in our patient cohort, we sought to determine if patient’s bone quality prior to surgery affects post-surgical pain. Bone quality was determined by measuring bone mineral density (BMD) and serum levels of C-terminal telopeptides of type I collagen (CTX-I) and osteocalcin (OCN). CTX-I is a byproduct of osteoclastic activity representative of bone resorption whereas OCN increase is representative of bone deposition. We hypothesize that patients with higher bone resorption and lower BMD have an increase in post-surgical pain. METHODS: 182 participants ages 50-85 receiving TKA were enrolled in the study. Patients with rheumatoid arthritis and/or C-reactive protein >20mg/L were excluded. Perioperative serum and tibial plateau bone samples were collected. Women with Knee Injury and Osteoarthritis Outcome Scores (KOOS) taken 90-days post TKA (n=31) had serum analyzed by enzyme-linked immunosorbent assay (ELISA) for CTX-I and OCN. BMD of the subchondral region of the tibial plateau was randomly measured for 14 of the 31 patient samples using an ex vivo micro-computed tomography (μCT) scanner. Pearson’s correlation analysis was run. RESULTS: We found increased CTX-I serum levels correlated with a lower (worse) KOOS pain score at 90-days post TKA (Pearson r= -.4911, p<.01). Additionally, we found an increase in BMD correlated with higher (better) KOOS pain score 90-days post TKA (Pearson r= .641, p<.02). The median 90-day post TKA pain score was 67.8. When separated into low and high pain groups, there was a significant increase in BMD in the low pain group (low>60; high<60, p<.01). We did not find a significant correlation between OCN serum levels and post-operative KOOS score. DISCUSSION: Our findings highlight further advantages of screening for BMD or other measures of bone health prior to surgery. Patient’s with elevated bone resorption marker (CTX¬I) and lower bone mineral density have worse self-reported pain outcomes 90 days after Total Joint Arthroplasty. SIGNIFICANCE: Our findings suggest bone resorption and bone mineral density could be pre¬operative predictors of pain 90 days after surgery and potentially would allow surgeons to give patient specific treatment such as mitigating patient expectations, surgical alterations, or pre-surgical treatment.
Recommended Citation
Valentino, John; Langley, Michael; Watt, James; and Ronis, Martin, "Is poor bone quality associated with pain after total knee arthroplasty (TKA)?" (2019). Medical Student Research Poster Symposium. 43.
https://digitalscholar.lsuhsc.edu/sommrd/2019/posters/43
Is poor bone quality associated with pain after total knee arthroplasty (TKA)?
Medical Education Building, LSUHSC-NO
INTRODUCTION: Osteoporosis is drastically underdiagnosed in patients who undergo TKA for osteoarthritis [1]. Previous research by our group found in a cohort of 204 Louisiana patients undergoing TKA who also met the United States Preventative Services Task Force (USPSTF) criteria for bone mineral density screening, only 20% had actually been screened [2]. While there are obvious consequences of underdiagnosis – increased risk of fracture or a change in surgical procedure [3,4], current guidelines from the American Academy of Orthopaedic Surgeons (AAOS) do not offer a recommendation regarding BMD screening for TKA patients [5]. Because screening for BMD is under-utilized in our patient cohort, we sought to determine if patient’s bone quality prior to surgery affects post-surgical pain. Bone quality was determined by measuring bone mineral density (BMD) and serum levels of C-terminal telopeptides of type I collagen (CTX-I) and osteocalcin (OCN). CTX-I is a byproduct of osteoclastic activity representative of bone resorption whereas OCN increase is representative of bone deposition. We hypothesize that patients with higher bone resorption and lower BMD have an increase in post-surgical pain. METHODS: 182 participants ages 50-85 receiving TKA were enrolled in the study. Patients with rheumatoid arthritis and/or C-reactive protein >20mg/L were excluded. Perioperative serum and tibial plateau bone samples were collected. Women with Knee Injury and Osteoarthritis Outcome Scores (KOOS) taken 90-days post TKA (n=31) had serum analyzed by enzyme-linked immunosorbent assay (ELISA) for CTX-I and OCN. BMD of the subchondral region of the tibial plateau was randomly measured for 14 of the 31 patient samples using an ex vivo micro-computed tomography (μCT) scanner. Pearson’s correlation analysis was run. RESULTS: We found increased CTX-I serum levels correlated with a lower (worse) KOOS pain score at 90-days post TKA (Pearson r= -.4911, p<.01). Additionally, we found an increase in BMD correlated with higher (better) KOOS pain score 90-days post TKA (Pearson r= .641, p<.02). The median 90-day post TKA pain score was 67.8. When separated into low and high pain groups, there was a significant increase in BMD in the low pain group (low>60; high<60, p<.01). We did not find a significant correlation between OCN serum levels and post-operative KOOS score. DISCUSSION: Our findings highlight further advantages of screening for BMD or other measures of bone health prior to surgery. Patient’s with elevated bone resorption marker (CTX¬I) and lower bone mineral density have worse self-reported pain outcomes 90 days after Total Joint Arthroplasty. SIGNIFICANCE: Our findings suggest bone resorption and bone mineral density could be pre¬operative predictors of pain 90 days after surgery and potentially would allow surgeons to give patient specific treatment such as mitigating patient expectations, surgical alterations, or pre-surgical treatment.