Thinner femoral cortical thickness in patients with destructive rheumatoid arthritis of the knee

Rika Kakutani; Naoki Kondo; Go Yamako; Tomoharu Mochizuki; Keiichiro Someya; Hiroyuki Kawashima

doi:10.1186/s13018-023-04340-0

Thinner femoral cortical thickness in patients with destructive rheumatoid arthritis of the knee

J Orthop Surg Res. 2023 Nov 9;18(1):850. doi: 10.1186/s13018-023-04340-0.

Authors

Rika Kakutani¹, Naoki Kondo², Go Yamako³, Tomoharu Mochizuki¹, Keiichiro Someya¹, Hiroyuki Kawashima¹

Affiliations

¹ Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi Dori, Chuo-ku, Niigata, 951-8510, Japan.
² Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi Dori, Chuo-ku, Niigata, 951-8510, Japan. Naokikondo1214@gmail.com.
³ Department of Mechanical Engineering, Faculty of Engineering, University of Miyazaki, Miyazaki, Japan.

Abstract

Background: The examination of femoral cortical bone thickness in patients with rheumatoid arthritis (RA) has been notably limited in prior research. We aimed to compare femoral cortical thickness in patients with rheumatoid arthritis (RA) and healthy controls and to investigate the association between femoral cortical thickness and clinical parameters within the RA group.

Methods: Forty-four patients (58 limbs) with RA who underwent total knee arthroplasty were enrolled. Preoperative computed tomography images of the lower limbs were analyzed. The femoral cortex was divided into the proximal, central, and distal diaphysis regions and further into the anterior, posterior, medial, and lateral regions. The divisions were measured using Stradwin® software and standardized by femoral length. Femoral cortical thickness was compared between RA and healthy control (n = 25) groups. Correlation analyses between standardized cortical thickness and disease parameters were performed in the RA group.

Results: The RA group had significantly lower standardized femoral cortical thickness at the anterior and medial distal diaphysis than healthy controls. Standardized proximal lateral and central lateral in the RA group were significantly larger than those in the healthy control groups. Standardized femoral cortical thickness was significantly correlated with bone mineral density (BMD) in 11 areas, except the posterior central diaphysis, and with body mass index in 8 areas, except the central posterior, distal lateral, distal anterior, and distal medial diaphysis.

Conclusions: Femoral cortical thinning was noted in patients with RA complicated with destructive knee, particularly at the anterior and medial distal diaphysis. Femoral cortical thickness was significantly correlated with BMD and body mass index (BMI); thus, patients with RA and low BMD and BMI should be cared for to prevent fragility fractures.

Keywords: Body mass index; Bone mineral density; Computed tomography; Femoral cortical thickness; Rheumatoid arthritis.

MeSH terms

Arthritis, Rheumatoid* / complications
Arthritis, Rheumatoid* / diagnostic imaging
Bone Density
Femur / diagnostic imaging
Fractures, Bone*
Humans
Lower Extremity