Quantitative Radiographic Assessment of Cancellous Bone Changes in the Proximal Tibia After Total Knee Arthroplasty: a 3-year Follow-up Study

The objective of this study was to determine whether fractal signature analysis (FSA) of digitized macroradiographs of knees with prosthetic implants quantifies alterations in tibial trabecular structure surrounding the implant over a 3-year period. Nineteen knees (16 patients) with arthroplasty had macroradiographs (×4) at baseline and annually for 3 years. The regions of interest (ROIs) were located in the medial and lateral plateau, midstem, and apical sites. FSA of horizontal and vertical trabecular organization was measured at each ROI, and the changes at the yearly visits were compared to the baseline values. Compared to the baseline values, FSA of the first-year radiographs detected a significant (P < 0.05) decrease in the number of vertical trabeculae in the medial compartment, and vertical, and horizontal trabeculae in the lateral compartment. During the second year, bone remodeling led to an increase in the number of horizontal trabeculae in the medial compartment, and vertical, and horizontal trabeculae in the lateral compartment. During the third year, there was a significant increase (P < 0.05) in the number of vertical and some horizontal trabeculae in both the medial and lateral compartments. Overall trabecular changes were significantly greater in the lateral than in the medial compartment. Following total knee arthroplasty, the response of bone showed that the first year was characterized by trabecular loss in response to posttraumatic osteopenia following surgery. By the third year, this process had reversed, with a significant increase in mainly vertical and some horizontal trabeculae in both the medial and lateral compartments, with only the lateral compartment showing an overall loss in small- and medium-sized trabeculae by the end of the study period.