Introduction:​ Quantitative computed tomography based finite element modeling (QCT-FE) has potential to clarify the role of subchondral bone stiffness in osteoarthritis. The limited spatial resolution of clinical QCT systems, however, results in partial volume (PV) artifacts and low contrast between cortical and trabecular bone, which adversely affects the accuracy of QCT-FE models. The objective of this research was to evaluate the agreement between stiffness predictions offered by QCT-FE models of proximal tibial subchondral bone (constructed with and without a new voxel-exclusion algorithm) with experimentally-derived local subchondral bone structural stiffness.

Methods:​ Thirteen proximal tibial compartments were obtained and imaged using QCT. Two types of QCT-FE models were developed:​ (1) standard model, which employed the standard procedure for QCT-FE modeling;​ and (2) “voxel exclusion (VE)” model, which addressed PV artifacts by excluding low density voxels during the material mapping stage of construction. We assessed agreement between QCT-FE stiffness estimates (using standard and VE approaches) with experimental stiffness by reporting predicted variance from linear regression and mean bias with 95% Limits of Agreement (LOA).

Results:​ The standard and VE models explained 81% and 84% of the variance in experimentally measured stiffness, respectively. The standard model showed a mean bias of -268 N/mm (LOA -1210 to 679 N/mm);​ the VE model showed a mean bias of +59 N/mm (LOA -762 to 910 N/mm).

Interpretation:​ The VE model explained more variance in subchondral bone stiffness with less bias. Our findings indicate that the VE method has potential to improve QCT-FE models of bone affected by PV artifacts.