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Use of High Resolution Dual-Energy X-Ray Absorptiometry-Region Free Analysis (DXA-RFA) to Detect Local Periprosthetic Bone Remodeling Events

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Use of High Resolution Dual-Energy X-Ray Absorptiometry-Region Free Analysis (DXA-RFA) to Detect Local Periprosthetic Bone Remodeling Events This is a repository copy of Use of high resolution dual-energy x-ray absorptiometry-region free analysis (DXA-RFA) to detect local periprosthetic bone remodeling events.. White Rose Research Online URL for this paper: http://eprints.whiterose.ac.uk/85663/ Version: Accepted Version Article: Wilkinson, J.M., Morris, R.M., Martin-Fernandez, M.A. et al. (4 more authors) (2015) Use of high resolution dual-energy x-ray absorptiometry-region free analysis (DXA-RFA) to detect local periprosthetic bone remodeling events. Journal of Orthopaedic Research, 33 (5). 712 - 716. https://doi.org/10.1002/jor.22823 Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. 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[email protected] https://eprints.whiterose.ac.uk/ Journal of Orthopaedic Research Use of High Resolution Region-Free Bone Densitometry (DXA-RFA) To Detect Local Peri rosthetic Bone Remodeling Events For Peer Review Journal: Journal of Orthopaedic Research Manuscript ID: JOR-14-0531.R1 Wiley - Manuscript type: Research Article Member) Date Submitted by the Author: n/a Complete List of Authors: Wilkinson, J, -ni.ersity of Sheffield, Academic -nit of /one Metabolism, Morris, Richard Martin-0ernande1, Miguel 3o1o, Jose 0rangi, Ale4 Maheson, Marci 5ang, Lang, -ni.ersity of Sheffield, Di.ision of Clinical Sciences 6eywords: D8A, bone remodeling John Wiley & Sons, Inc. Page 1 of 16 Journal of Orthopaedic Research 1 2 3 Use of High Resolution Dual-energy X-ray Absorptiometry-Region Free 4 5 6 Analysis (DXA-RFA) To Detect Local eriprosthetic Bone Remodeling 7 8 Events 9 10 11 12 JM Wilkinson[1], RM Morris[1], MA Martin-Fernandez[2], JM Pozo [2], AF Frangi[2], 13 14 Marci Maheson[3], L ang[1] 15 16 17 18 For Peer Review 19 20 [1]University of Sheffield, Academic Unit of Bone Metabolism, Northern General Hospital, 21 22 Sheffield, U-. [2]University of Sheffield, Centre for Computational 1maging 2 Simulation 23 24 Technologies in Biomedicine 4C1ST1B5, Department of Mechanical Engineering, Sheffield, 25 26 27 U-. [3] University Hospital of Wales, Department of Trauma and 8rthopaedics, Cardiff, U-. 28 29 30 31 32 33 Correspondence and reprint re:uests to: 34 35 36 Prof J Mark Wilkinson 37 38 39 Department of Human Metabolism, University of Sheffield, DU24, The Medical School, 40 41 Beech Hill Road, Sheffield, S10 2RX, United -ingdom 42 43 44 Email: [email protected] 45 46 47 Telephone +44 114 271 4705 48 49 50 Fax +44 114 261 775 51 52 53 54 55 56 57 58 59 60 1 John Wiley & Sons, Inc. Journal of Orthopaedic Research Page 2 of 16 1 2 3 ABSTRACT 4 5 6 Dual energy x-ray absorptiometry 4DXA5 is the gold standard method for measuring 7 8 periprosthetic bone remodeling, but relies on a region of interest 4R815 analysis approach. 9 10 Whilst this addresses issues of anatomic variability it is insensitive to bone remodeling events 11 12 13 at the sub-R81 level. We have validated a high-spatial resolution tool, termed DXA-Region- 14 15 Free Analysis 4DXA-RFA5 that uses advanced image processing approaches to allow 16 17 :uantitation of bone mineral density 4BMD5 at the individual pixel 4data-point5 level. Here 18 For Peer Review 19 we compared the resolution of bone remodeling measurements made around a stemless 20 21 22 femoral prosthesis in 1A subBects over 24 months using R81-based analysis versus that made 23 24 using DXA-RFA. Using the R81 approach the regional pattern of BMD change varied by 25 26 region, with greatest loss in R81C 420D, PE0.0015, and largest gain in R814 46D, PE0.0C5. 27 28 Analysis using DXA-RFA showed a focal zone of increased BMD localized to the prosthesis- 29 30 bone interface 430-40D, PE0.0015 that was not resolved using conventional DXA analysis. 31 32 33 The 20D bone loss observed in R81C with conventional DXA was resolved to a focal area 34 35 adBacent to the cut surface of the infero-medial femoral neck 4up to -40D, PE0.00015. DXA- 36 37 RFA enables high resolution analysis of DXA datasets without the limitations incurred using 38 39 R81-based approaches. 40 41 42 Keywords: bone mineral density, femur, total hip arthroplasty, dual energy x-ray 43 44 45 absorptiometry region-free analysis. 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 2 John Wiley & Sons, Inc. Page 3 of 16 Journal of Orthopaedic Research 1 2 3 INTR,DUCTI,N 4 5 Dual energy x-ray absorptiometry 4DXA5 is the gold standard method for measuring bone 6 7 remodeling events that occur following total hip arthroplasty 4THA5. However, current 8 9 10 analysis approaches express BMD as an average value within a given region of interest 11 1 12 4R815. This value is calculated as the mean BMD value derived from large numbers of 13 14 pixels contained within the defined R81. However, bone remodeling events occurring after 15 16 prosthesis insertion are spatially-complex and may not be uniform across a given R81,2 For 17 18 For Peer Review 19 example, within a large R81 the BMD change occurring over a given time at the bone- 20 2 21 prosthesis interface may differ substantially to that occurring at the bone periosteal surface. 22 23 Such differences cannot be resolved using R81-based DXA analysis technology, whilst the 24 25 alternate computed tomography-based approach is accompanied with a higher radiation 26 27 exposure dose.3. 4 Further, different R81 models may also be re:uired to measure BMD 28 29 C-7 30 change around prostheses with differing geometries, making :uantitative comparisons of 31 32 bone remodeling between prostheses challenging. 33 34 35 1n order to solve these issues we recently developed and validated a high-spatial 36 37 resolution tool for measuring femoral periprosthetic BMD change events, termed DXA- 38 39 Region-Free Analysis 4DXA-RFA5.A This analysis approach uses the data contained within a 40 41 42 standard DXA ac:uisition and applies contemporary image processing techni:ues to allow 43 9. 10 44 full statistical use of the spatial information contained within each DXA scan, shedding 45 46 this limitation of R81-based analysis approaches. 47 48 49 1n this study we compared and contrasted the sensitivity of DXA-RFA versus R81- 50 51 based DXA analysis to detect BMD change over 24 months in the setting of a stemless, 52 53 54 hydroxyapatite-coated femoral prosthesis 4The Silent hip prosthesis, DePuy 1nternational Ltd, 55 56 Leeds, U-5. Specifically, we aimed to determine whether DXA-RFA provides greater 57 58 analysis resolution of local bone remodeling events. 59 60 3 John Wiley & Sons, Inc. Journal of Orthopaedic Research Page 4 of 16 1 2 3 -ETH,DS 4 5 Study design, recruitment, and randomization 6 7 8 The DXA scans were collected as part of a single-center, prospective cohort study of 1A 9 10 patients undergoing primary THA using the Silent Hip. The study was approved by the South 11 12 West National Health Service Research Ethics Committee, U- 40CIWSE02I1335, and all 13 14 patients provided written, informed, consent prior to inclusion. The inclusion criteria were 15 16 adult males and females with osteoarthritis of the hip re:uiring THA, and considered suitable 17 18 For Peer Review 19 for a cementless prosthesis. The exclusion criteria were pregnancy, known drug or alcohol 20 21 abuse or psychological disorders that could affect care or treatment outcomes, participation in 22 23 clinical trials of an investigational medical product within the last 6 months, osteonecrosis of 24 25 the femoral neck, PagetJs disease, significant bone loss or gross deformity in the region of the 26 27 28 femoral neck identified on pre-operative radiographs, and patients with Charnley C functional 29 30 classification. All operations were performed through a posterior approach with the patient in 31 32 the lateral position. The femoral and acetabular components were inserted with a press-fit 33 34 techni:ue in accordance with the manufacturerJs instructions. All patients were mobilized on 35 36 the first or second post-operative day with unrestricted weight bearing. 37 38 39 Patient monitoring and assessments 40 41 A Harris Hip Score and an 8xford hip score were assessed pre-operatively, and 3, 6, 12, and 42 43 24 months post-operatively.11. 12 Patients underwent DXA of the operated hip at post- 44 45 operative baseline within 10 days of surgery, and at months 3, 6, 12, and 24 thereafter. All 46 47 48 ac:uisitions were made using the same Hologic Discovery fan beam densitometer 4Hologic 49 50 1nc, Bedford, MA, USA5 using the Kmetal-removal hipL scanning mode. 51 52 53 DXA scan analysis using con,entional R.I approach 54 55 56 57 58 59 60 4 John Wiley & Sons, Inc.
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