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Liu C, Xu Z, Zeng JF, Song ZQ, Xie YY, Tang ZW, Wen J, Xiao S. Roles of combined femoral and acetabular anteversion in pathological changes of hip dysplasia and hip reconstructive surgery. World J Orthop 2024; 15:390-399. [PMID: 38835688 PMCID: PMC11145975 DOI: 10.5312/wjo.v15.i5.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/10/2024] [Accepted: 04/24/2024] [Indexed: 05/15/2024] Open
Abstract
Combined femoral and acetabular anteversion is the sum of femoral and acetabular anteversion, representing their morphological relationship in the axial plane. Along with the increasing understanding of hip dysplasia in recent years, numerous scholars have confirmed the role of combined femoral and acetabular anteversion in the pathological changes of hip dysplasia. At present, the reconstructive surgery for hip dysplasia includes total hip replacement and redirectional hip preservation surgery. As an important surgery index, combined femoral and acetabular anteversion have a crucial role in these surgeries. Herein, we discuss the role of combined femoral and acetabular anteversion in pathological changes of hip dysplasia, total hip replacement, and redirectional hip preservation surgery.
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Affiliation(s)
- Can Liu
- Department of Anatomy, Hunan Normal University School of Medicine, Changsha 410003, Hunan Province, China
| | - Zheng Xu
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jian-Fa Zeng
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhen-Qi Song
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Yu-Yin Xie
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhong-Wen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
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Rezaei A, Michael S, Eldib A, Puri L. Relative Acetabular Retroversion and Its Association With Earlier-Onset Symptomatic Osteoarthritis of the Hip. Arthroplast Today 2024; 26:101322. [PMID: 38455866 PMCID: PMC10918484 DOI: 10.1016/j.artd.2024.101322] [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] [Received: 08/06/2023] [Revised: 09/23/2023] [Accepted: 01/21/2024] [Indexed: 03/09/2024] Open
Abstract
Background Hip osteoarthritis is associated with an aging population with the average total hip arthroplasty patient in the U.S. approximately 65 years of age. Although there is an association between femoroacetabular impingement and early arthritis, there is a paucity of data attributed to variation in native acetabular version and early onset osteoarthritis. We investigated that whether patients with relative acetabular retroversion are predisposed to earlier hip osteoarthritis. Methods Five hundred sixteen charts of patients undergoing THA by a single surgeon between March 2018 and May 2022 were reviewed (221 male and 295 female subjects; mean age 66.7 years [standard deviation (SD) 9.8]). Patients with advanced dysplasia, who are post-traumatic, septic, have inflammatory arthritis, and osteonecrosis were excluded. Operative hip anteversion was measured using three-dimensional computed tomography. A univariate analysis was used to correlate the age of male and female subjects with anteversion angles of ≤15° and >15°. The effect of age and gender on version angle was studied using a multivariate linear regression model. Results In patients with anteversion ≤15°, both male (P = .006) and female subjects (P = .015) presented at significantly lesser age (male: 98, avg. age: 63.7, SD: 8.7; female: 62, avg. age: 64.8, SD: 9.8) than those with anteversion >15° (male: 123, avg. age: 67.2, SD: 10.2; female: 233, avg. age: 68.2, SD: 9.8). Male subjects had lower anteversion than female subjects with age held constant (P < .001), and older patients had increased anteversion with gender held constant (P < .001). Conclusions This study suggests that patients with a relatively decreased version angle (≤15°) are more likely to present with earlier-onset symptomatic hip osteoarthritis.
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Affiliation(s)
- Arash Rezaei
- Department of Orthopedic Surgery, University of Illinois – Chicago, Chicago, IL, USA
| | - Stojanovic Michael
- Department of Orthopaedic Surgery, NorthShore Orthopaedic & Spine Institute, Skokie, IL, USA
| | - Ahmed Eldib
- Department of Orthopaedic Surgery, NorthShore Orthopaedic & Spine Institute, Skokie, IL, USA
| | - Lalit Puri
- Department of Orthopaedic Surgery, NorthShore Orthopaedic & Spine Institute, Skokie, IL, USA
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Cho Y, Shin J, Kim S. Acetabular, Femoral, and Combined Anteversion in a Province in South Korea: Computed Tomography-Based Study. Clin Orthop Surg 2023; 15:567-573. [PMID: 37529189 PMCID: PMC10375808 DOI: 10.4055/cios22350] [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] [Received: 11/01/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 08/03/2023] Open
Abstract
Background The purpose of this study was to investigate the femoral, acetabular, and combined anteversion of the hip joint in South Koreans using computed tomography (CT). Methods We measured anteversion using CT venograms taken from 2016 to 2020. Of the total 1,073 patients, 952 patients were included in the study except for those with pelvic fractures, previous femoral fractures, childhood hip joint disease, osteoarthritis, or hip dysplasia (lateral center-edge angle, < 20), foreigners, and hip and knee replacement patients. Measurements were taken twice by two orthopedic surgeons. Results The femoral anteversion in women was 10.64° ± 10.26° (≤ 49 years), 15.75° ± 9.40° (50-59 years), 10.81° ± 9.14° (60-69 years), 12.38° ± 8.55° (70-79 years), and 11.23° ± 8.44° (≥ 80 years). The femoral anteversion in men was 12.02° ± 11.38° (≤ 49 years), 10.62° ± 9.11° (50-59 years), 6.09° ± 9.95° (60-69 years), 6.57° ± 9.51° (70-79 years), and 5.53° ± 9.29° (≥ 80 years). The acetabular anteversion in women was 17.65° ± 6.58° (≤ 49 years), 19.24° ± 6.42° (50-59 years), 20.30° ± 6.25° (60-69 years), 22.38° ± 7.36° (70-79 years), and 23.34° ± 6.98° (≥ 80 years). The acetabular anteversion in men was 15.21° ± 8.14° (≤ 49 years), 17.68° ± 6.00° (50-59 years), 17.54° ± 5.93° (60-69 years), 18.68° ± 6.62° (70-79 years), and 18.19° ± 6.94° (≥ 80 years). The combined anteversion in women was 28.29° ± 14.30° (≤ 49 years), 34.99° ± 10.62° (50-59 years), 31.11° ± 11.52° (60-69 years), 34.76° ± 10.86° (70-79 years), and 34.57° ± 11.45° (≥ 80 years). The combined anteversion in men was 27.23° ± 15.11° (≤ 49 years), 28.30° ± 11.23° (50-59 years), 23.63° ± 11.77° (60-69 years), 25.25° ± 12.02° (70-79 years), and 23.72° ± 11.88° (≥ 80 years). Conclusions Femoral anteversion tended to decrease with age in men and acetabular anteversion tended to increase in both men and women. Combined anteversion showed a tendency to increase slightly in women.
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Affiliation(s)
- Youngho Cho
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Jaeuk Shin
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
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van Erp JHJ, Snijders TE, Weinans H, Castelein RM, Schlösser TPC, de Gast A. The role of the femoral component orientation on dislocations in THA: a systematic review. Arch Orthop Trauma Surg 2022; 142:1253-1264. [PMID: 34101017 PMCID: PMC9110501 DOI: 10.1007/s00402-021-03982-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Dislocation remains a major complication in total hip arthroplasty (THA), in which femoral component orientation is considered a key parameter. New imaging modalities and definitions on femoral component orientation have been introduced, describing orientation in different planes. This study aims to systematically review the relevance of the different orientation parameters on implant stability. METHODS A systematic review was performed according to the PRISMA guidelines to identify articles in the PubMed and EMBASE databases that study the relation between any femoral component orientation parameters and implant stability in primary THA. RESULTS After screening for inclusion and exclusion criteria and quality assessment, nine articles were included. Definitions to describe the femoral component orientation and methodologies to assess its relevance for implant stability differed greatly, with lack of consensus. Seven retrospective case-control studies reported on the relevance of the transversal plane orientation: Low femoral- or low combined femoral and acetabular anteversion was statistical significantly related with more posterior dislocations, and high femoral- or combined femoral and acetabular anteversion with anterior dislocations in two studies. There were insufficient data on sagittal and coronal component orientation in relation to implant stability. CONCLUSION Because of incomparable definitions, limited quality and heterogeneity in methodology of the included studies, there is only weak evidence that the degree of transverse component version is related with implant stability in primary THA. Recommendations about the optimal orientation of the femoral component in all three anatomical planes cannot be provided. Future studies should uniformly define the three-dimensional orientation of the femoral component and systematically describe implant stability.
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Affiliation(s)
- Joost H. J. van Erp
- Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands
- Clinical Orthopedic Research Center m-N, Zeist, The Netherlands
- Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - Thom E. Snijders
- Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands
- Clinical Orthopedic Research Center m-N, Zeist, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | | | - Arthur de Gast
- Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands
- Clinical Orthopedic Research Center m-N, Zeist, The Netherlands
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Hevesi M, Wyles CC, Rouzrokh P, Erickson BJ, Maradit-Kremers H, Lewallen DG, Taunton MJ, Trousdale RT, Berry DJ. Redefining the 3D Topography of the Acetabular Safe Zone: A Multivariable Study Evaluating Prosthetic Hip Stability. J Bone Joint Surg Am 2022; 104:239-245. [PMID: 34958643 DOI: 10.2106/jbjs.21.00406] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dislocation is the most common reason for early revision following total hip arthroplasty (THA). More than 40 years ago, Lewinnek et al. proposed an acetabular "safe zone" to avoid dislocation. While novel at the time, their study was substantially limited according to modern standards. The purpose of this study was to determine optimal acetabular cup positioning during THA as well as the effect of surgical approach on the topography of the acetabular safe zone and the hazard of dislocation. METHODS Primary THAs that had been performed at a single institution from 2000 to 2017 were reviewed. Acetabular inclination and anteversion were measured using an artificial intelligence neural network; they were validated with performance testing and comparison with blinded grading by 2 orthopaedic surgeons. Patient demographics and dislocation were noted during follow-up. Multivariable Cox proportional-hazards regression, including multidimensional analysis, was performed to define the 3D topography of the acetabular safe zone and its association with surgical approach. RESULTS We followed 9,907 THAs in 8,081 patients (4,166 women and 3,915 men; 64 ± 13 years of age) for a mean of 5 ± 3 years (range: 2 to 16); 316 hips (3%) sustained a dislocation during follow-up. The mean acetabular inclination was 44° ± 7° and the mean anteversion was 32° ± 9°. Patients who did not sustain a dislocation had a mean anteversion of 32° ± 9° (median, 32°), with the historic ideal anteversion of 15° observed to be only in the third percentile among non-dislocating THAs (p < 0.001). Multivariable modeling demonstrated the lowest dislocation hazards at an inclination of 37° and an anteversion of 27°, with an ideal modern safe zone of 27° to 47° of inclination and 18° to 38° of anteversion. Three-dimensional analysis demonstrated a similar safe-zone location but significantly different safe-zone topography among surgical approaches (p = 0.03) and sexes (p = 0.02). CONCLUSIONS Optimal acetabular positioning differs significantly from historic values, with increased anteversion providing decreased dislocation risk. Additionally, surgical approach and patient sex demonstrated clear effects on 3D safe-zone topography. Further study is needed to characterize the 3D interaction between acetabular positioning and spinopelvic as well as femoral-sided parameters. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Pouria Rouzrokh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Radiology Informatics Laboratory, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Bradley J Erickson
- Radiology Informatics Laboratory, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Choice of surgical approach influences the combined anteversion needed for a stable and impingement-free total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:1023-1028. [PMID: 33222111 DOI: 10.1007/s00590-020-02837-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Accurate component positioning is the key for successful outcome after total hip arthroplasty (THA). Positioning acetabular and femoral components in a safe zone of 25°-50° on the basis of combined anteversion (CA) has shown to reduce instability and impingement. This safe zone was described for THAs performed through the posterior approach and has not been validated for other surgical approaches. METHODS Seventy patients who underwent unilateral uncemented THA were included in the study; 35 patients-using posterior approach and the remaining 35-using trans-gluteal approach. All patients included had a stable and impingement-free THA at a mean follow-up of 39.2 ± 9.5 months. CT scan was performed to assess component positioning by calculating CA. The values were compared between the two groups to study possible differences. RESULTS CA in the trans-gluteal group was significantly lower (32° ± 3.7° vs 38.4° ± 4.6°, P < .001) compared to posterior group. The difference in CA was due to the differences in acetabular anteversion, which was significantly low in the trans-gluteal group than the posterior group (22.1° ± 3.6° vs 27.8° ± 4.2°, P < .001). The mean femoral anteversion was similar in both groups. All trans-gluteal hips fell within the safe zone of 20°-40°, and all posterior hips fell within the safe zone of 25°-50°. CONCLUSION A safe zone of 25°-50° is valid for THAs performed from the posterior approach but not universally applicable. For trans-gluteal approach, a safe zone of 20°-40° is better to provide a stable and impingement-free THA. CA varies with the surgical approach. THAs performed through the trans-gluteal approach can be stable and impingement-free with lesser CA compared to THAs performed through the posterior approach.
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CT Based Analysis of Acetabular Morphology in Northern Indian Population: A Retrospective Study. Indian J Orthop 2020; 55:606-613. [PMID: 33995863 PMCID: PMC8081800 DOI: 10.1007/s43465-020-00267-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/16/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The acetabular morphology has shown to differ among different regions of the world. Multiplanar evaluation by computed tomography (CT) scan is the key to assess acetabular depth, version, and inclination at the same time which have been rarely explored before in the Indian population. We present an anthropometric study of the native acetabulum by CT based coronal, sagittal, and axial parameters in the Northern Indian population. METHODS The acetabular anteversion (AA), acetabular angle of sharp (AAS), sagittal acetabular angle (SAA), lateral center edge angle (LCEA), acetabular depth (AD), acetabular horizontal offset (AHO), extrusion index (EI) and acetabular depth ratio (ADR) was measured in CT scans of 122 patients (244 hips) without any bony pathologies. LCEA < 20°, ADR < 250, AD < 9 mm, AAS > 43°, and EI ≥ 25% were taken as criteria for dysplastic acetabulum. RESULTS There were 62 males and 60 females included in the study with a mean age of 63.8 ± 17.2 years (21-98 years). In this study, females were having significantly lower ADR (p = 0.002) and higher EI (p = 0.01) than males. The prevalence of dysplasia was 3.2% according to LCEA and 1.6% while combining all of the criteria. CONCLUSION There are prominent differences in acetabular depth in the Indian population compared with the population of Western countries or other parts of Asia. Females were shown to have shallower acetabulum than males. The comparative analysis of radiographic parameters obtained from our study with the data available on different country-based studies can help better understanding the acetabular morphology of Indian as well as the worldwide population. LEVEL OF STUDY Retrospective cross-sectional study.
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de Pina Cabral F, Figueiredo F, Todorski I, Toledo de Araujo LC, Locks R, Aguiar DP. Femoral torsion evaluation by computed tomography in a young Brazilian population with hip pain and femoroacetabular impingement. J Orthop 2020; 18:32-35. [PMID: 32189880 DOI: 10.1016/j.jor.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/19/2019] [Indexed: 01/17/2023] Open
Abstract
Introduction The aim of the study was to evaluate femoral torsion (FT) by computed tomography (CT) in young patients with hip pain and femoroacetabular impingement (FAI) in a Brazilian population. After the diagnosis of impingement, the complete analysis from the hip biomechanics and morphology has become essential. Methods Forty-one patients from 18 to 45 years presenting hip pain without arthrosis (Tönnis<2) were evaluated by CT scan from February 2017 to February 2018. All patients presented hip pain for at least 3 months and FAI. They have followed the same radiographic protocol and modified Harris Hip Score (mHHS) evaluation. Statistical analyses by software R version 3.4.4. with significance p < 0,05. Results After exclusion criterias, twenty-six patients (9 bilateral) were included, mostly man (73%). The average age was 35 years for both genders. BMI was 19 kg/m2 for women and 24 kg/m2 for men and the mean modified Harris Hip Score was 67 points. We have found femoral torsion changes in 11 hips with pain (31%) and high variability (60%). The mean FT was 14,5°, ranging from 0 to 39°. Patients with hip pain, CAM impingement and altered FT had no correlation when compared to controls (without pain) (p = 0.234), neither Mixed impingement (p = 0.314). Patients with Pincer impingement and painful hips had higher FT (16,63°) than controls (11,77°) (p = 0.045). Conclusion: The presence of torsional alterations in almost 1/3 of the patients with FAI and the high variability reveal the importance of measuring FT at this disease.
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Affiliation(s)
- Fernando de Pina Cabral
- Department of Orthopaedics, SOS Cardio Hospital, Rodovia SC 401, 121 Itacorubi, Florianópolis, SC, Brazil
| | - Felipe Figueiredo
- Department of Reserch, National Institute of Traumatology and Orthopaedics Jamil Haddad, Av. Brasil, 500 Caju, Rio de Janeiro, RJ, Brazil
| | - Inga Todorski
- Department of Radiology, Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Lucio C Toledo de Araujo
- Department of Orthopaedics, Regional Hospital of São José Dr Homero de Miranda Gomes, R. Adolfo Donato da Silva S/n Praia Comprida, São José, SC, Brazil
| | - Renato Locks
- Department of Orthopaedics, Regional Hospital of São José Dr Homero de Miranda Gomes, R. Adolfo Donato da Silva S/n Praia Comprida, São José, SC, Brazil
| | - Diego Pinheiro Aguiar
- Department of Reserch, National Institute of Traumatology and Orthopaedics Jamil Haddad, Av. Brasil, 500 Caju, Rio de Janeiro, RJ, Brazil
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Abstract
Intoeing, a common entrance complaint in infants, toddlers, and young children, is best defined as internal rotation of the long axis of the foot to the line of progression. Intoeing may be caused by primary deformities within the foot, issues with tibial torsion, and femoral antetorsion (anteversion). Problems within the foot include hallux varus, metatarsus adductus, talipes equinovarus, and pes cavus, each of which has specific treatments available. Treatment must be individualized, and the risks and complications weighed against the predictable morbidity of intoeing.
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Affiliation(s)
- Edwin Harris
- Department of Orthopaedics and Rehabilitation, Loyola University Chicago, Stritch School of Medicine, 2160 South First Avenue, Maywood, IIlinois; Private Practice, 10540 West Cermak Road, Westchester, IL 60154, USA.
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Morphometric assessment of the hip joint in the Estrela Mountain Dog breed. Vet Comp Orthop Traumatol 2012; 25:202-10. [PMID: 22367104 DOI: 10.3415/vcot-11-07-0101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 11/24/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To study the radiographic projected hip parameters of the proximal femur and acetabulum in young and adult Estrela Mountain Dogs with normal and abnormal hip joints. The parameters evaluated were: femoral angles of inclination and anteversion (FAI and FAA), femoral neck length and width (FNL and FNW), acetabular depth (AD) and acetabular angle of retrotorsion (AAR). METHODS Five hundred and twenty-five standard hip-extended ventrodorsal radiographic views and 622 mediolateral views of the right and left femur were used to measure the FAI, FAA, FNL, FNW, AD, AAR and modified AAR (mAAR). RESULTS The FAI decreased in adult dysplastic dogs, in females and in right femora; FAA decreased with age; FNL was characterized by a greater relative size in normal adult animals; FNW was greater in abnormal hips in young and adult animals; AD was less in adult dysplastic dogs and in right hips; AAR was similar in the studied groups; mAAR was greater in abnormal hips and in left hips. CLINICAL SIGNIFICANCE The data may be used in future studies, which compare this breed to others. Morphological variations in femoral neck and acetabular morphometric parameters were present, and these variables in dogs with different ages and with hips in varying states of health should not be compared.
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Abstract
BACKGROUND With contemporary canal-filling press-fit stems, there is no adjustability of stem position in the canal and therefore the canal anatomy determines stem version. Stem version will affect head/neck impingement, polyethylene wear from edge loading, and hip stability, but despite this, the postoperative version of a canal-filling press-fit stem is unclear. QUESTIONS/PURPOSES Is there a difference between the version of the nonoperated femur and the final version of a canal-filling press-fit femoral component? Could a difference create an alignment problem for the hip replacement? METHODS Sixty-four hips were studied with fluoroscopy and 46 nonarthritic and 41 arthritic hips were studied with MRI. A standardized fluoroscopic technique for determining preoperative and postoperative femoral version was developed with the patient supine on a fracture table undergoing supine total hip arthroplasty. To validate the methods, the results were compared with two selected series of axial MRI views of the hip comparing the version of the head with the version of the canal at the base of the neck. RESULTS For the operated hips, the mean anatomic hip version was less than the stem version: 18.9° versus 27.0°. The difference on average was 8.1° of increased anteversion (SD, 7.4°). Both MRI series showed the femoral neck was more anteverted on average than the femoral head, thereby explaining the operative findings. CONCLUSION With a canal-filling press-fit femoral component there is wide variation of postoperative component anteversion with most stems placed in increased anteversion compared with the anatomic head. The surgical technique may need to adjust for this if causing intraoperative impingement or instability.
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Rawal BR, Ribeiro R, Malhotra R, Bhatnagar N. Anthropometric measurements to design best-fit femoral stem for the Indian population. Indian J Orthop 2012; 46:46-53. [PMID: 22345806 PMCID: PMC3270605 DOI: 10.4103/0019-5413.91634] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The standard commercially available marketed prostheses sometimes may not be the best fit to Indian patients because of the large anatomic variation. Orthopedic surgeons always stress the need for a proper implant-patient match in hip joint replacements, in particular, for a cementless femoral stem. The complications of mismatch are aseptic loosening, improper load distribution, and discomfort. The present study was undertaken to compare the differences in dimensions between femurs of elderly Indians and those of populations from other regions in order to solve the problem of a possible geometric mismatch between a selected implant and the hip joint as far as Indian patients are concerned. MATERIALS AND METHODS Measurements were made using computer aided design techniques on computed tomography (CT) scanned images of 98 femurs (56 left and 42 right). The software used to convert the CT images into solid models was MIMICS(®) (Materialize, Inc., Leuven, Belgium). The geometrical parameters, viz., the femoral head offset, femoral head center (HC), femoral head diameter, femoral head relative position, position of shaft isthmus, neck-shaft angle, bow angle, femoral neck length, canal flare index, femoral length, and canal width at various locations, were chosen to design best-fit standard femoral stems for cementless insertion. These data were compared with the published data of other countries. RESULTS A difference of 16.8% was found in the femoral head offset between Indian and Swiss populations, which can affect soft tissue tension and range of motion. At a distance of 20 mm above the lesser trochanter (LT), the anteroposterior (AP) canal width was found to differ by 45.4%, when compared with a French population which can affect the mechanical stability of femoral stem. Femoral dimensions of Indian male and female subjects have also been compared and differences evaluated. At the LT, the aspect ratio (ratio of mediolateral canal width and AP canal width) in case of males (1.198) is approximately13% higher than that of females (1.059). CONCLUSIONS This study indicates a need for redesign of femoral stems. The obtained anthropometric femoral dimensions can be used to design and develop indigenous hip joint prosthesis in India. The results of this study can also be used in forensic anthropometric studies.
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Affiliation(s)
- BR Rawal
- Department of Mechanical Engineering, Indian Institute of Technology, Delhi, India
| | - Rahul Ribeiro
- Department of Mechanical Engineering, Indian Institute of Technology, Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Naresh Bhatnagar
- Department of Mechanical Engineering, Indian Institute of Technology, Delhi, India
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