Quantifying Pelvic Periprosthetic Bone Remodeling Using Dual-Energy X-Ray Absorptiometry Region-Free Analysis

The gold standard tool for measuring periprosthetic bone mineral density (BMD) is dual-energy X-ray absorptiometry (DXA). However, resolution of the method is limited due to the aggregation of pixel data into large regions of interest for clinical and statistical analysis. We have previously validated a region-free analysis method (DXA-RFA) for quantitating BMD change at the pixel level around femoral prostheses. Here, we applied the DXA-RFA method to the pelvis, and quantitated its precision in this setting using repeated DXA scans taken on the same day after repositioning in 29 patients after total hip arthroplasty. Scans were semiautomatically segmented using edge detection, intensity thresholding, and morphologic operations, and elastically registered to a common template generated through generalized Procrustes analysis. Pixel-wise BMD precision between repeated scans was expressed as a coefficient of variation %. Longitudinal BMD change was assessed in an independent group of 24 patients followed up for 260 wk. DXA-RFA spatial resolution of 0.31 mm2 provided approximately 12,500 data points per scan. The median data-point precision was 17.8% (interquartile range 14.3%-22.7%). The anatomic distribution of the precision errors showed poorer precision at the bone borders and superior precision to the obturator foramen. Evaluation of longitudinal BMD showed focal BMD change at 260 wk of -26.8% adjacent to the prosthesis-bone interface (1% of bone map area). In contrast, BMD change of +39.0% was observed at the outer aspect of the ischium (3% of bone map area). Pelvic DXA-RFA is less precise than conventional DXA analysis. However, it is sensitive for detecting local BMD change events in groups of patients, and provides a novel tool for quantitating local bone mass after joint replacement. Using this method, we were able to resolve BMD change over small areas adjacent to the implant-bone interface and in the ischial region over 260 wk after total hip arthroplasty.