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Tao K, Wang SC, Ma XY, Shao L, Di ZL, Huang ZY. Three-dimensional femur morphology analysis for the optimal location of subtrochanteric osteotomy with an implanted Wagner cone stem in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip. J Orthop Surg Res 2023; 18:410. [PMID: 37277880 DOI: 10.1186/s13018-023-03901-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/02/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND This study aimed to accurately evaluate the matching of proximal and distal femoral segments and fitting of the femur-femoral stem in patients with Crowe type IV developmental dysplasia of the hip (DDH) who have undergone subtrochanteric osteotomy at different locations with an implanted Wagner cone stem to improve the rate of the bone union at the osteotomy site. METHODS Three-dimensional femur morphology of 40 patients with Crowe type IV DDH was evaluated at each cross-section to determine the femoral cortical bone area. This study focused on five osteotomy lengths (2.5, 3, 3.5, 4, and 4.5 cm). The overlapped area between the proximal and distal cortical bone segments was defined as the contact area (S, mm2), and the contact area to distal cortical bone area ratio was defined as the coincidence rate (R). Three indicators were used to evaluate the matching and fitting of the osteotomy sites with the implanted Wagner cone stems: (1) higher S and R between the proximal and distal segments; (2) the effective fixation length of the femoral stem at the distal segments being at least 1.5 cm; and (3) osteotomy did not involve the isthmus. RESULTS In all groups, S significantly decreased in the two proximal levels above the 0.5 cm level below the lesser trochanter (LT) compared with those below this level. In comparison, at osteotomy lengths from 2.5 to 4 cm, R significantly decreased in the three proximal levels. The optimal osteotomy levels ranged from 1.5 and 2.5 cm below the LT for an appropriately sized stem. CONCLUSIONS Subtrochanteric osteotomy at the optimal level not only ensures fitting of the femur-femoral stem but also meets the requirements of a higher S and R to ensure adequate reduction and stabilization at the osteotomy site, which may contribute to the bone union. Although the optimal osteotomy level varies with the size of the femoral stem and the length of the subtrochanteric osteotomy, the optimal osteotomy levels for an appropriately sized Wagner cone femoral stem implantation range from 1.5 to 2.5 cm below the LT.
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Affiliation(s)
- Kun Tao
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, 315040, China
| | - Shi-Cheng Wang
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, 315040, China
| | - Xiao-Ying Ma
- Beijing Naton Medical Technology Holdings Co., Ltd., Beijing, 100094, China
| | - Long Shao
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, 315040, China
| | - Zheng-Lin Di
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, 315040, China
| | - Zhe-Yu Huang
- The Department of Orthopedics Surgery, Ningbo No. 6 Hospital, 1059# ZhongShan East Road, Ningbo, 315040, China.
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Morphological Measurement of the Femoral Anterior Bow in Chinese Population Based on Three-Dimensional Computed Tomography. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7674764. [PMID: 34778457 PMCID: PMC8589507 DOI: 10.1155/2021/7674764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/21/2021] [Indexed: 11/17/2022]
Abstract
Purpose The femoral anterior bow is an important factor in matching a femoral implant to a femur. However, its morphology in the Chinese population has rarely been reported. In this study, a three-dimensional measurement approach was adopted to provide accurate data. The aim was to supply a reference for designing a long-stemmed femoral prosthesis that is more suitable for Chinese people. Methods Computed tomography data were collected from both lower limbs of 96 normal volunteers and reconstructed into a three-dimensional model using Mimics software. The parameters of the femoral anterior bow were measured using medical image analysis software. Statistical analysis was conducted using independent-samples and paired-samples t-tests with SPSS software. Results All the indexes showed significant sexual difference (P < 0.05). The minimum cross-sectional area of the femoral medullary cavity was larger in men (10.77 ± 1.53 mm) than in women (9.79 ± 1.27 mm). The distance from the position of the maximum curvature to the lower edge of the lesser trochanter was also larger in men (60.93 ± 5.81 mm) than in women (56.31 ± 2.80 mm). However, the curvature of the femoral medullary cavity centerline was larger in women (883.57 ± 249.74 mm) than in men (958.79 ± 266.61 mm). The femoral anterior bow morphological indexes of Chinese subjects were different from the published data for other populations. There were no significant differences between left and right femoral anterior bows in either sex (P > 0.05). Conclusion The three-dimensional measurement approach adopted in this study is more convenient and accurate than previous conventional methods, with high repeatability. The morphological indexes of the femoral anterior bow in this research suggest that population characteristics should be taken into account. This study will provide references for the design of long-stemmed femoral prostheses in the Chinese population.
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Yang Y, Liao W, Yi W, Jiang H, Fu G, Ma Y, Zheng Q. Three-dimensional morphological study of the proximal femur in Crowe type IV developmental dysplasia of the hip. J Orthop Surg Res 2021; 16:621. [PMID: 34663420 PMCID: PMC8522035 DOI: 10.1186/s13018-021-02789-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background When performing femoral reconstruction in patients with Crowe type IV developmental dysplasia of the hip (DDH), anatomical deformity presents many technical challenges to orthopedic surgeons. The false acetabulum is suggested to influence load transmission and femoral development. The aim of this study was to describe the morphological features of dysplastic femurs in Crowe type IV DDH and further evaluate the potential effect of the false acetabulum on morphological features and medullary canal of Crowe type IV femurs. Methods We analyzed preoperative computed tomography scans from 45 patients with 51 hips (25 hips without false acetabulum in the IVa group and 26 hips with false acetabulum in the IVb group) who were diagnosed with Crowe type IV DDH and 30 normal hips in our hospital between January 2009 and January 2019. Three-dimensional reconstruction was performed using Mimics software, and the coronal femoral plane was determined to evaluate the following parameters: dislocation height, dislocation ratio, height of the femoral head (FH), height of the greater trochanter (GT), GT–FH height discrepancy, height of the isthmus, neck-shaft angle, femoral offset and anteversion of the femoral neck. The mediolateral (ML) width, anterolateral (AP) width and diameter of medullary canal of the proximal femur were measured on the axial sections. Further, canal flare index (CFI), metaphyseal-CFI and diaphyseal-CFI were also calculated. Results Compared with the normal femurs, the Crowe type IV DDH femurs had a higher femoral head, larger GT–FH height discrepancy, larger femoral neck anteversion, higher isthmus position and smaller femoral offset. Dislocation height and dislocation rate were significantly larger in the IVa DDH group (65.34 ± 9.83 mm vs. 52.24 ± 11.42 mm). Further, the IVb femurs had a significantly lower isthmus position, larger neck-shaft angle and smaller femoral neck anteversion than IVa femurs. The ML, AP canal widths and the diameter of medullary canal in both DDH groups were significantly smaller than the normal group. Dimensional parameters of IVa femurs were also narrower than IVb femurs in most sections, but with no difference at the level of isthmus. According to the CFIs, the variation of proximal medullary canal in IVb femurs was mainly located in the diaphyseal region, while that in IVa femurs was located in the whole proximal femur. Conclusions High dislocated femurs are associated with more anteverted femoral neck, smaller femoral offset and narrower medullary canal. Without stimulation of the false acetabulum, IVa DDH femurs were associated with higher dislocation and notably narrower medullary canal, whose variation of medullary canal was located in the whole proximal femur.
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Affiliation(s)
- Yuhui Yang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Weihong Liao
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Weiqun Yi
- Department of Operating Room, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, People's Republic of China
| | - Hai Jiang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Guangtao Fu
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yuanchen Ma
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, People's Republic of China.
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, People's Republic of China.
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