Poor Bone Quality Alert
DXA is a poor measure of extremity bone quality. Using indirect measures of bone quality like DXA is not an accurate way to predict bone quality for the foot and ankle surgeon.
Outcomes parallel bone quality
Poor quality, measured by DXA and quantitative CT, showed compromised patient reported outcome scores in Total Knee patients. Local bone quality, including mineral bone quality and micro-architecture, affects outcome of TKA and presumably total ankle as well.
Cortical bone thickness is a screening tool
Cortical bone thickness (CBT), measured on the AP view, has been a useful measure of 'at risk’ osteoporosis tibial bone in two different studies. In the context of total ankle arthroplasty CBT < 4 mm correlated to a higher risk of early aseptic loosening in non-stemmed total ankle implants.
Perhaps this simple measure could give us more information than a DXA and be an indication for a stemmed tibial implant.