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Sanchis-Alfonso V, Ramírez-Fuentes C, Beser-Robles M, Roselló-Añón A, Chiappe C, Martí-Bonmatí L, Doménech-Fernández J. Increased femoral anteversion in females with anterior knee pain relates to both the neck and the shaft of the femur. Arch Orthop Trauma Surg 2024; 144:51-57. [PMID: 37610697 DOI: 10.1007/s00402-023-05036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/13/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Increased femoral anteversion (FAV) can have many clinical manifestations, including anterior knee pain (AKP). To our knowledge, no studies have measured the location of FAV in a cohort of female AKP patients. The objective of this research is to determine whether the increased FAV in AKP females originates above the lesser trochanter, below the lesser trochanter or at both levels. MATERIALS AND METHODS Thrity-seven consecutive AKP female patients (n = 66 femurs) were recruited prospectively. There were 17 patients (n = 26 femurs; mean age of 28 years) in whom the suspicion for the increased FAV of the femur was based on the clinical examination (pathological group-PG). The control group (CG) consisted of 20 patients (n = 40 femurs; mean age of 29 years) in whom there was no increased FAV from the clinical standpoint. All of them underwent a torsional computed tomography of the lower limbs. FAV was measured according to Murphy´s method. A segmental analysis of FAV was performed using the lesser trochanter as a landmark. RESULTS Significant differences in the total FAV (18.7 ± 5.52 vs. 42.46 ± 6.33; p < 0.001), the neck version (54.88 ± 9.64 vs. 64.27 ± 11.25; p = 0.0006) and the diaphysis version (- 36.17 ± 8.93 vs. - 21.81 ± 11.73; p < 0.001) were observed between the CG and the PG. The difference in the diaphyseal angle between CG and PG accounts for 60% of the total difference between healthy and pathological groups, while the difference between both groups in the angle of the neck accounts for 40%. CONCLUSION In chronic AKP female patients with increased FAV, the two segments of the femur contribute to the total FAV, with a different pattern among patients and controls, being the compensation mechanism of the diaphysis much lower in the pathological femurs than in the controls.
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Affiliation(s)
- Vicente Sanchis-Alfonso
- Department of Orthopedic Surgery, Hospital Arnau de Vilanova, C/ San Clemente 12, 46015, Valencia, Spain.
| | | | - María Beser-Robles
- GIBI230 Research Group on Biomedical Imaging, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Alejandro Roselló-Añón
- Department of Orthopedic Surgery, Hospital Arnau de Vilanova, C/ San Clemente 12, 46015, Valencia, Spain
| | - Caterina Chiappe
- Department of Orthopedic Surgery, Hospital Arnau de Vilanova, C/ San Clemente 12, 46015, Valencia, Spain
| | - Luis Martí-Bonmatí
- Department of Radiology, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
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Usami T, Takada N, Kosuwon W, Paholpak P, Tokunaga M, Iwata H, Hattori Y, Nagaya Y, Murakami H, Kuroyanagi G. A Lateral Fracture Line Affects Femoral Trochanteric Fracture Instability and Swing Motion of the Intramedullary Nail: A Biomechanical Study. JB JS Open Access 2024; 9:e23.00118. [PMID: 38352644 PMCID: PMC10860993 DOI: 10.2106/jbjs.oa.23.00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background An unstable trochanteric femoral fracture is a serious injury, with a 1-year mortality rate of 5.4% to 24.9%, for which there is currently no standard treatment method. The lag screw insertion site is one of the primary contact areas between the cortical bone and an intramedullary nail. We hypothesized that a posterolateral fracture causes intramedullary nail instability when the posterolateral fracture line interferes with lag screw insertion. The purpose of the present study was to investigate the effect of posterolateral fracture line morphology on intramedullary nail stability by simulating unstable trochanteric femoral fractures with a posterolateral fracture fragment. Methods Eighteen custom-made synthetic osteoporotic bone samples were used in the present study. Nine samples had a posterolateral fracture line interfering with the lag screw insertion hole (Fracture A), and the other 9 had a fracture line 10 mm away from the hole (Fracture B). Cyclic loading (750 N) was applied to the femoral head 1,500 times. Movement of the end cap attached to the intramedullary nail was recorded. The amplitudes of motion in the coronal plane (coronal swing motion), sagittal plane (sagittal swing motion), and axial plane (total swing motion) were evaluated. The change in the neck-shaft angle was evaluated on photographs that were made before and after the test. Medial cortical displacement was measured before and after the test. Results Two Fracture-A samples were excluded because the amplitude of sagittal swing motion was too large. The mean values for coronal, sagittal, and total swing motion were 1.13 ± 0.28 mm and 0.51 ± 0.09 mm (p < 0.001), 0.50 ± 0.12 mm and 0.46 ± 0.09 mm (p = 0.46), and 1.24 ± 0.24 mm and 0.69 ± 0.11 mm (p < 0.001) for Fractures A and B, respectively. The mean neck-shaft angle change was -8.29° ± 2.69° and -3.56° ± 2.35° for Fractures A and B, respectively (p = 0.002). The mean displacement of the medial cortex was 0.38 ± 1.12 mm and 0.12 ± 0.37 mm for Fractures A and B, respectively (p = 0.57). Conclusions This study showed that an unstable trochanteric femoral fracture with a posterolateral fracture line that interferes with the lag screw insertion holes is a risk factor for increased intramedullary nail instability.
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Affiliation(s)
- Takuya Usami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
- Department of Orthopaedic Surgery, Nagoya City University East Medical Center, Nagoya, Aichi, Japan
| | - Naoya Takada
- Department of Orthopaedic Surgery, Kainan Hospital, Yatomi, Aichi, Japan
| | - Weerachai Kosuwon
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Permsak Paholpak
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Masami Tokunaga
- Department of Orthopaedic Surgery, Fukuoka Orthopaedic Hospital, Fukuoka, Fukuoka, Japan
| | - Hidetoshi Iwata
- Department of Orthopaedic Surgery, Kainan Hospital, Yatomi, Aichi, Japan
| | - Yusuke Hattori
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
- Department of Orthopaedic Surgery, Nagoya City University East Medical Center, Nagoya, Aichi, Japan
| | - Yuko Nagaya
- Department of Orthopaedic Surgery, Nagoya City University East Medical Center, Nagoya, Aichi, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Gen Kuroyanagi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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Scorcelletti M, Zange J, Böcker J, Sies W, Lau P, Mittag U, Reeves ND, Ireland A, Rittweger J. Associations between long-term exercise participation and lower limb joint and whole-bone geometry in young and older adults. Front Physiol 2023; 14:1150562. [PMID: 37250122 PMCID: PMC10211427 DOI: 10.3389/fphys.2023.1150562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction: Features of lower limb bone geometry are associated with movement kinematics and clinical outcomes including fractures and osteoarthritis. Therefore, it is important to identify their determinants. Lower limb geometry changes dramatically during development, partly due to adaptation to the forces experienced during physical activity. However, the effects of adulthood physical activity on lower limb geometry, and subsequent associations with muscle function are relatively unexplored. Methods: 43 adult males were recruited; 10 young (20-35 years) trained i.e., regional to world-class athletes, 12 young sedentary, 10 older (60-75 years) trained and 11 older sedentary. Skeletal hip and lower limb geometry including acetabular coverage and version angle, total and regional femoral torsion, femoral and tibial lateral and frontal bowing, and frontal plane lower limb alignment were assessed using magnetic resonance imaging. Muscle function was assessed recording peak power and force of jumping and hopping using mechanography. Associations between age, training status and geometry were assessed using multiple linear regression, whilst associations between geometry and muscle function were assessed by linear mixed effects models with adjustment for age and training. Results: Trained individuals had 2° (95% CI:0.6°-3.8°; p = 0.009) higher femoral frontal bowing and older individuals had 2.2° (95% CI:0.8°-3.7°; p = 0.005) greater lateral bowing. An age-by-training interaction indicated 4° (95% CI:1.4°-7.1°; p = 0.005) greater acetabular version angle in younger trained individuals only. Lower limb geometry was not associated with muscle function (p > 0.05). Discussion: The ability to alter skeletal geometry via exercise in adulthood appears limited, especially in epiphyseal regions. Furthermore, lower limb geometry does not appear to be associated with muscle function.
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Affiliation(s)
- Matteo Scorcelletti
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
- Manchester Metropolitan University Institute of Sport, Manchester, United Kingdom
- Werner Siemens-Endowed Chair for Innovative Implant Development (Fracture Healing), Division of Surgery, Saarland University, Homburg, Germany
| | - Jochen Zange
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Jonas Böcker
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Wolfram Sies
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Patrick Lau
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Uwe Mittag
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Neil D. Reeves
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
- Manchester Metropolitan University Institute of Sport, Manchester, United Kingdom
| | - Alex Ireland
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
- Manchester Metropolitan University Institute of Sport, Manchester, United Kingdom
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Department of Paediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
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Coordinate value of the femoral head center estimated using those of the tip of the greater trochanter and lesser trochanter. Sci Rep 2023; 13:2784. [PMID: 36797444 PMCID: PMC9935852 DOI: 10.1038/s41598-023-30063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
Several studies have reported estimating the femoral head center (FC) from reference points on the pelvis; however, none have reported estimates obtained from those on the femur. In this cross-sectional study, we investigated the estimated point of FC from the coordinate value of the tip of the greater trochanter (GT) and lesser trochanter (LT) using a formula with a three-dimensional measurement technique. We used data from 92 healthy Japanese subjects without any back or knee symptoms and no abnormalities in the hip, knee, or spine on plain radiographs. In our study, the difference in the anteroposterior direction was larger than that in the other directions. We speculate that the accuracy of defining the tip of the LT is difficult in the anteroposterior direction. Moreover, the correlation coefficients were larger for women. The reason for this was unclear because the variation in the proximal femur may be similar in women. We found that the average difference between the actual and calculated values was approximately 2 mm. We considered that the coordinate value of the FC from the tip of the GT could be estimated more accurately using the regression equation compared to previous methods based on pelvic reference points.
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Curley AJ, Ruh ER, Shah A, Disantis AE, Krivoniak A, Mauro CS, McClincy MP. A systematic approach to CT evaluation of non-arthritic hip pain. EFORT Open Rev 2022; 7:653-662. [PMID: 36125004 PMCID: PMC9624481 DOI: 10.1530/eor-22-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Bone morphology has been increasingly recognized as a significant variable in the evaluation of non-arthritic hip pain in young adults. Increased availability and use of multidetector CT in this patient population has contributed to better characterization of the osseous structures compared to traditional radiographs. Femoral and acetabular version, sites of impingement, acetabular coverage, femoral head–neck morphology, and other structural abnormalities are increasingly identified with the use of CT scan. In this review, a standard CT imaging technique and protocol is discussed, along with a systematic approach for evaluating pelvic CT imaging in patients with non-arthritic hip pain.
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Affiliation(s)
- Andrew J Curley
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ethan R Ruh
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amisha Shah
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ashley E Disantis
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - April Krivoniak
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Craig S Mauro
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael P McClincy
- Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Scorcelletti M, Kara S, Zange J, Jordan J, Semler O, Schönau E, Rittweger J, Ireland A, Seefried L. Lower limb bone geometry in adult individuals with X-linked hypophosphatemia: an observational study. Osteoporos Int 2022; 33:1601-1611. [PMID: 35435480 PMCID: PMC9187561 DOI: 10.1007/s00198-022-06385-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/25/2022] [Indexed: 12/05/2022]
Abstract
UNLABELLED We assessed lower-limb geometry in adults with X-linked hypophosphatemia (XLH) and controls. We found large differences in multiple measures including femoral and tibial torsion, bowing and cross-sectional area and acetabular version and coverage which may contribute to clinical problems such as osteoarthritis, fractures and altered gait common in XLH. PURPOSE Individuals with X-linked hypophosphatemia (XLH) are at risk of lower-limb deformities and early onset of osteoarthritis. These two factors may be linked, as altered biomechanics is a risk factor for osteoarthritis. This exploratory evaluation aims at providing clues and concepts for this association to facilitate future larger-scale and longitudinal studies on that aspect. METHODS For this observational study, 13 patients with XLH, aged 18-65 years (6 female), were compared with sex-, age- and weight-matched healthy individuals at a single German research centre. Femoral and hip joint geometry, including femoral and tibial torsion and femoral and tibial shaft bowing, bone cross-sectional area (CSA) and acetabular version and coverage were measured from magnetic resonance imaging (MRI) scans. RESULTS Total femoral torsion was 29° lower in individuals with XLH than in controls (p < 0.001), mainly resulting from lower intertrochanteric torsion (ITT) (p < 0.001). Femoral lateral and frontal bowing, tibial frontal bowing, mechanical axis, femoral mechanical-anatomical angle, acetabular version and acetabular coverage were all greater and tibial torsion lower in individuals with XLH as compared to controls (all p < 0.05). Greater femoral total and marrow cavity CSA, greater tibial marrow cavity CSA and lower cortical CSA were observed in XLH (all p < 0.05). DISCUSSION We observed large differences in clinically relevant measures of tibia and particularly femur bone geometry in individuals with XLH compared to controls. These differences may plausibly contribute to clinical manifestations of XLH such as early-onset osteoarthritis, pseudofractures and altered gait and therefore should be considered when planning corrective surgeries.
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Affiliation(s)
- Matteo Scorcelletti
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Serhan Kara
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
| | - Jochen Zange
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
| | - Jens Jordan
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
| | - Oliver Semler
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Eckhard Schönau
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Jörn Rittweger
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Alex Ireland
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Lothar Seefried
- Orthopaedic Department, University of Würzburg, Wurzburg, Germany.
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Torsional Abnormality: The Forgotten Issue in the Diagnosis and Treatment of the Anterior Knee Pain Patient. J Clin Med 2022; 11:jcm11123530. [PMID: 35743600 PMCID: PMC9225002 DOI: 10.3390/jcm11123530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 02/05/2023] Open
Abstract
Currently, no one doubts that the vast majority of anterior knee pain (AKP) cases do not need surgery [...].
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Shepherd MC, Gaffney BMM, Song K, Clohisy JC, Nepple JJ, Harris MD. Femoral version deformities alter joint reaction forces in dysplastic hips during gait. J Biomech 2022; 135:111023. [PMID: 35247684 PMCID: PMC9064981 DOI: 10.1016/j.jbiomech.2022.111023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 10/19/2022]
Abstract
Developmental dysplasia of the hip (DDH) causes hip instability and early-onset osteoarthritis. The focus on pathomechanics in DDH has centered on the shallow acetabulum, however there is growing awareness of the role of femoral deformities in joint damage. The objective of this study was to determine the influence of femoral version (FV) on the muscle and joint reaction forces (JRFs) of dysplastic hips during gait. Magnetic resonance images, in-vivo gait data, and musculoskeletal models were used to calculate JRFs and simulate changes due to varying FV deformities. Rotation about the long axis of the femur was added in the musculoskeletal models to simulate FV values from -5° (relative retroversion) to + 35° (increased anteversion). In our simulations, FV deformities caused the largest changes to the anteroposterior and resultant JRFs. From a normal FV of 15°, a 15° increase in femoral anteversion caused JRFs to be less posterior in early stance (Δ = 0.43 ± 0.22 xbodyweight) and more anterior in late stance (Δ = 0.60 ± 14 xbodyweight). Relative retroversion caused anteroposterior changes that were similar to anteversion in early stance but opposite in late stance. Resultant JRFs experienced the largest changes during late stance where anteversion raised the peak by 0.48 ± 0.15 xbodyweight and relative retroversion lowered the peak by 0.32 ± 0.30 xbodyweight. Increasing anteversion increased hip flexor and abductor muscle forces, which caused the changes in JRFs. Identifying how FV deformities influence hip joint loading can elucidate their role in the mechanisms of hip degeneration in patients with DDH.
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Affiliation(s)
- Molly C Shepherd
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado-Denver, Denver, CO, USA
| | - Ke Song
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael D Harris
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA; Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, USA; Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
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Flury A, Aregger F, Rahm S, Hoch A, Zingg PO. Subtrochanteric osteotomy in the management of femoral maltorsion results in anteroposterior malcorrection of the greater trochanter: computed simulations of 3D surface models of 100 cadavers. Hip Int 2022; 33:525-532. [PMID: 35067083 PMCID: PMC10170563 DOI: 10.1177/11207000211071046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM The purpose of this study was to investigate the greater trochanter's (GT) behaviour in simulated subtrochanteric osteotomy. MATERIALS AND METHODS Measurement of functional and anatomical femoral torsion, and position of the GT and lesser trochanter was performed using 3-dimensional (3D) surface models of 100 cadaveric femora. Femoral torsion between 2° and 22° was defined as normal, femora with <2° and >22° of femoral torsion were assigned to the low- and high-torsion group. Subtrochanteric osteotomy was simulated to normalise torsional deformities to 12°. RESULTS With subtrochanteric osteotomy, functional torsion was simultaneously corrected while adjusting anatomical torsion (R2 = 0.866, p < 0.001). Compared to the normal-torsion group, an anteroposterior (AP) overcorrection of ±0.5 centimetres (range 0.02-1.1 cm) of the GT resulted in the high- and low-torsion group, respectively (p < 0.001): Mean AP GT distance to a standardised coronal plane was 2.1 ± 0.3 cm (range 12-30 cm) in the normal-torsion group compared to 1.61 ± 0.1 cm (range 1.4-1.71 cm) and 2.6 ± 0.6 cm (range 1.8-3.6 cm) for the corrected high and low-torsion groups, respectively. The extent of the GT shift in AP direction correlated strongly with the extent to which anatomical femoral torsion was corrected (R2 = 0.946; p < 0.001). CONCLUSIONS Subtrochanteric osteotomy for femoral maltorsion reliably adjusts anatomical and functional torsion, but also results in a ±1 cm AP shift of the GT per 10° of torsional correction. However, this effect of the procedure is most likely not clinically relevant in relation to hip abductor performance.
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Affiliation(s)
- Andreas Flury
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | - Fabian Aregger
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | | | - Armando Hoch
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | - Patrick O Zingg
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
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Age-related decrease in supratrochanteric torsion and increase in infratrochanteric torsion in healthy pediatric femurs: an MRI study. J Pediatr Orthop B 2021; 30:324-330. [PMID: 32649421 DOI: 10.1097/bpb.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of the study was to evaluate the correlation between femoral anteversion, supratrochanteric torsion (STT), and infratrochanteric torsion (ITT) in healthy developing pediatric femurs using MRI. This study included 282 (164 males and 118 females) patients aged 1-18 years. The axial MRI of patients with benign tumoral lesions of the femur was retrospectively reviewed. The measurements were performed through axial images of contralateral healthy femurs. Femoral anteversion, STT, and ITT were measured twice by two orthopedic surgeons. The Pearson correlation coefficient was used to test for the correlation of age between STT, ITT, and femoral anteversion in children. All femoral anteversion, STT, and ITT measurements showed excellent intraobserver and interobserver reliability (P < 0.001). The mean STT changed from 68.5° to 37.2° ± 4.2, the mean ITT changed from -37.4° to -21.2° ± 4.2, and the mean femoral anteversion changed from 31.1° to 18.8° ± 2.2 in patients aged 1-18 years. Through the linear regression model, STT, ITT, and femoral anteversion had a significant association (P < 0.001) with age. For an increase of one year in age, the corresponding STT decreased 1.32 times (P < 0.001, R2 = 0.510), the corresponding ITT increased 0.39 times (P < 0.001, R2 = 0.079), and the corresponding femoral anteversion decreased 0.94 times (P < 0.001, R2 = 0.507). ITT increases and STT decreases with age. The decrease in STT contributes more to femoral anteversion than does the increase in ITT. STT and ITT contribute to femoral anteversion with different patterns according to age.
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Tamaki Y, Goto T, Takasago T, Wada K, Hamada D, Sairyo K. Proximal Femoral Rotational Osteotomy for Symptomatic Femoral Retroversion : A Case Report. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 67:214-216. [PMID: 32378613 DOI: 10.2152/jmi.67.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The Rotational osteotomy for femoral retroversion has been extremely rare despite the known association between femoral neck retroversion, hip pain, and osteoarthritis. Here, we describe a case of femoral neck retroversion for which proximal femoral rotation osteotomy. A 16-year-old boy with a past history of developmental dysplasia of the both hip treated conservatively presented with a complaint of pain in left hips. On physical examination, flexion of the left hip was limited to 90° with terminal pain. Internal rotation was also limited to 10°. Computed tomography (CT) showed -7.1° anteversion of the left femur. We performed rotational osteotomy to increase femoral anteversion because conservative treatment was not effective. The postoperative course was uneventful. At 12 postoperative months, his left hip pain was completely disappeared and femoral anteversion was 34° on CT scans. Retroversion of the femur is a distinct dynamic factor that should be considered in the evaluation of mechanical causes of hip pain. Restoring the normal rotational alignment of the hip resulted in cure of the impingement due to femoral retroversion. J. Med. Invest. 67 : 214-216, February, 2020.
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Affiliation(s)
- Yasuaki Tamaki
- Department of Orthopedic, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tomohiro Goto
- Department of Orthopedic, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tomoya Takasago
- Department of Orthopedic, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Keizo Wada
- Department of Orthopedic, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Daisuke Hamada
- Department of Orthopedic, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedic, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Scorcelletti M, Reeves ND, Rittweger J, Ireland A. Femoral anteversion: significance and measurement. J Anat 2020; 237:811-826. [PMID: 32579722 PMCID: PMC7542196 DOI: 10.1111/joa.13249] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/22/2022] Open
Abstract
Femoral neck anteversion (FNA) is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. Differences in FNA affect the biomechanics of the hip, through alterations in factors such as moment arm lengths and joint loading. Altered gait associated with differences in FNA may also contribute to the development of a wide range of skeletal disorders including osteoarthritis. FNA varies by up to 30° within apparently healthy adults. FNA increases substantially during gestation and thereafter decreases steadily until maturity. There is some evidence of a further decrease at a much lower rate during adulthood into old age, but the mechanisms behind it have never been studied. Development of FNA appears to be strongly influenced by mechanical forces experienced during everyday movements. This is evidenced by large differences in FNA in groups where movement is impaired, such as children born breech or individuals with neuromuscular conditions such as cerebral palsy. Several methods can be used to assess FNA, which may yield different values by up to 20° in the same participant. While MRI and CT are used clinically, limitations such as their cost, scanning time and exposure to ionising radiation limit their applicability in longitudinal and population studies, particularly in children. More broadly, applicable measures such as ultrasound and functional tests exist, but they are limited by poor reliability and validity. These issues highlight the need for a valid and reliable universally accepted method. Treatment for clinically problematic FNA is usually de-rotational osteotomy; passive, non-operative methods do not have any effect. Despite observational evidence for the effects of physical activity on FNA development, the efficacy of targeted physical activity remains unexplored. The aim of this review is to describe the biomechanical and clinical consequences of FNA, factors influencing FNA and the strengths and weaknesses of different methods used to assess FNA.
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Affiliation(s)
- Matteo Scorcelletti
- Department of Life SciencesResearch Centre for Musculoskeletal Science & Sports MedicineManchester Metropolitan UniversityManchesterUK
| | - Neil D. Reeves
- Department of Life SciencesResearch Centre for Musculoskeletal Science & Sports MedicineManchester Metropolitan UniversityManchesterUK
| | - Jörn Rittweger
- Institute of Aerospace MedicineGerman Aerospace Center (DLR)CologneGermany
- Department of Paediatrics and Adolescent MedicineUniversity of CologneCologneGermany
| | - Alex Ireland
- Department of Life SciencesResearch Centre for Musculoskeletal Science & Sports MedicineManchester Metropolitan UniversityManchesterUK
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Abstract
PURPOSE OF REVIEW Femoral derotational osteotomies are performed to correct residual symptomatic increased femoral torsion in adolescents and adults. Typical indications are anterior knee pain caused by patellar maltracking and patellofemoral instability. There is still no consensus as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a femoral derotational osteotomy. RECENT FINDINGS Good early clinical outcomes have been reported. However, long-term studies and data on return to play are lacking. Surgery often is performed according to the surgeon's experience. There is no evidence to support decisions regarding surgical technique or level of osteotomy. Femoral derotational osteotomy is the treatment of choice in patients with symptomatic excessive anteversion and torsional malalignment of the femur. Multiple techniques have shown good clinical results with high patient satisfaction. Future studies however must focus on radiographic and clinical assessment to understand different subtypes of torsional deformity and its implication on operative therapy.
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Affiliation(s)
- Manfred Nelitz
- Orthopaedic Specialty Clinic, MVZ Oberstdorf, Teaching Hospital University of Ulm, Trettachstrasse 16, 87561, Oberstdorf, Germany.
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Batailler C, Weidner J, Wyatt M, Dalmay F, Beck M. Position of the greater trochanter and functional femoral antetorsion: Which factors matter in the management of femoral antetorsion disorders? Bone Joint J 2018; 100-B:712-719. [PMID: 29855251 DOI: 10.1302/0301-620x.100b6.bjj-2017-1068.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Aims The primary aim of this study was to define and quantify three new measurements to indicate the position of the greater trochanter. Secondary aims were to define 'functional antetorsion' as it relates to abductor function in populations both with and without torsional abnormality. Patients and Methods Three new measurements, functional antetorsion, posterior tilt, and posterior translation of the greater trochanter, were assessed from 61 CT scans of cadaveric femurs, and their reliability determined. These measurements and their relationships were also evaluated in three groups of patients: a control group (n = 22), a 'high-antetorsion' group (n = 22) and a 'low-antetorsion' group (n = 10). Results In the cadaver group, the mean anatomical antetorsion was 14.7° (sd 8.5; 0 to 36.5) and the functional antetorsion 21.5° (sd 8.1; 3.6 to 44.3): the posterior tilt was 73.3° (sd 10.8; 46.9 to 88.7) and the posterior translation 0.59 (sd 0.2; 0.2 to 0.9). These measurements had excellent intra and interobserver agreement with a range from 0.93 to 0.99. When the anatomical antetorsion decreased, the greater trochanter was more tilted and translated posteriorly in relation to the axis of the femoral neck, and the difference between functional and anatomical antetorsion increased. The results the three patient groups were similar to those of the cadaver group. Conclusion The position of the greater trochanter and functional antetorsion varied with anatomical antetorsion. In the surgical management of femoral retrotorsion, subtrochanteric osteotomy can result in an excessively posterior position of the greater trochanter and an increase in functional antetorsion. Cite this article: Bone Joint J 2018;100-B:712-19.
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Affiliation(s)
- C Batailler
- CHU Lyon Croix-Rousse, Hospices Civils de Lyon, Lyon, France, Clinic for Orthopaedic and Trauma Surgery, Lucerne, Switzerland
| | - J Weidner
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - M Wyatt
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - F Dalmay
- Biostatistics Department, Limoges University, Limoges, France
| | - M Beck
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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MRI Assessment of Supra- and Infratrochanteric Femoral Torsion: Association With Femoroacetabular Impingement and Hip Dysplasia. AJR Am J Roentgenol 2018; 211:155-161. [PMID: 29733696 DOI: 10.2214/ajr.17.18882] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate a novel measurement technique for assessing the supra- and infratrochanteric components of femoral torsion, establish reference values in healthy volunteers, and compare supra- and infratrochanteric torsion angles in patients with hip dysplasia and patients with femoroacetabular impingement (FAI) with those in healthy volunteers. MATERIALS AND METHODS Femoral torsion was assessed in 380 patients and 61 healthy volunteers on MRI. For assessing supra- and infratrochanteric torsion, three measurement techniques (i.e., Kim, simplified Kim, and centroid methods) were evaluated by two readers on 100 patients. The technique with the highest interreader reliability was selected to perform measurements on all patients and volunteers. Supra- and infratrochanteric torsion angles of patients were stratified by hip disorders, which were diagnosed by specialized hip surgeons, and were compared with reference values of healthy volunteers. Statistical analysis included the independent t test, Mann-Whitney U test, and intraclass correlation coefficient (ICC). RESULTS The centroid method showed the highest interreader reliability for measuring supra-and infratrochanteric torsion with an ICC of 0.979. The supra- and infratrochanteric torsion values of the volunteers were 31.5° ± 7.4° (mean ± SD) and -18.3° ± 9.9°, respectively. In comparison with the volunteers, patients with hip dysplasia had significantly higher supraand infratrochanteric torsion values of 37.5° ± 10.3° (p = 0.001) and -9.6° ± 11.7° (p < 0.001) and patients with pincer-type FAI had significantly higher supratrochanteric torsion values of 37.8° ± 8.0° (p = 0.002). CONCLUSION The supra- and infratrochanteric components of femoral torsion differ substantially between hip disorders: Patients with hip dysplasia have predominantly increased infratrochanteric torsion, whereas patients with pincer-type FAI have increased supratrochanteric torsion. Quantification of separate supra- and infratrochanteric torsion angles allows a more detailed analysis of hip disorders and may influence treatment planning.
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