Effectiveness of combined anteversion angle technique in total hip arthroplasty for treatment of ankylosing spondylitis affecting hip joint / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of the combined anteversion angle technique in total hip arthroplasty (THA) for treating ankylosing spondylitis (AS) affecting the hip joint.@*METHODS@#A retrospective analysis was conducted on the clinical data of 73 patients with AS affecting the hip joint who underwent THA between August 2018 and August 2021. According to whether the combined anteversion angle technique was used in THA, the patients were divided into study group (37 cases, combined anteversion angle technique was used in THA) and control group (36 cases, traditional THA). There was no significant difference in baseline data such as gender, age, body mass index, disease duration, preoperative Harris score, range of motion (ROM), acetabular anteversion angle, acetabular abduction angle, femoral anteversion angle, and combined anteversion angle between the two groups ( P>0.05). The operation time, hospital stay, and complications of the two groups were recorded and compared. The Harris score and hip ROM were compared between the two groups before operation, at 1, 3, 6, 12 months after operation, and at last follow-up. The acetabular component anteversion angle, femoral component anteversion angle, acetabular component abduction angle, and component combined anteversion angle were measured postoperatively.@*RESULTS@#The operation time in the study group was significantly shorter than that in the control group ( P<0.05), and there was no significant difference in hospital stay between the two groups ( P>0.05). There was no intraoperative complication such as acetabular and proximal femoral fractures, neurovascular injuries in both groups, and the incisions healed by first intention. All patients were followed up 2-3 years, with an average of 2.4 years; there was no significant difference in the follow-up time between the two groups ( P>0.05). During the follow-up period, there was no complication such as hip dislocation, wound infection, delayed wound healing, deep venous thrombosis, and hip dislocation in both groups. The hip Harris score and ROM of the two groups gradually increased with time after operation, and the differences were significant when compared with those before operation ( P<0.05); the above two indicators of the study group were significantly better than those of the control group at each time point after operation ( P<0.05). Extensive bone ingrowth on the surface of the components could be observed in the anteroposterior X-ray films of the hip joint of the two groups at 12 months after operation, and the acetabular components was stable without femoral stem subsidence, osteolysis around the components, and heterotopic ossification. At last follow-up, the acetabular component anteversion angle, femoral component anteversion angle, and component combined anteversion angle in the study group were significantly superior to those in the control group ( P<0.05), except that there was no significant difference in the acetabular component abduction angle between the two groups ( P>0.05).@*CONCLUSION@#For patients with AS affecting the hip joint, the use of the combined anteversion angle technique during THA effectively promotes the recovery of hip joint function and enhances the postoperative quality of life of patients when compared to traditional THA.

Estudio cadavérico de anteversión de cuello femoral en Población de Indonesia / Cadaveric Study Of Femoral Neck Anteversion In Indonesian Population

Objective: The normal morphology of femoral anteversion is an essential factor which determines the clinical results of hip replacement to achieve the normal activity and the length of the replaced joint. No previous study has been documented regarding normal value of femoral anteversion in Indonesian population and how they are different with Western, India and African population. This study aimed on measurement of normal femoral anteversion values of Indonesian population and compare it with existing data of Western, African and India values. Method: This cross-sectional study by measuring the femoral neck anteversion angle in 120 samples of Indonesians's cadaveric femur. Comparisons were made between Western, African and India. Result: The result showed that the average values of femoral neck anteversion angle in men were 11.60 ± 4.83 and 12.96 ± 5.1 in the right and left parts respectively, while in women, the results were 14.83+-5.14 and 13.37+-5.66 in right and left parts. The p value of ≤ 0.05 was considered to be significant. Conclusion: The mean femoral anteversion values of Indonesian population is 13.22. It is significantly different in comparison with Western, African, and Indian population.

Effect of automatic angle measuring instrument on long-term outcome and prognosis of patients with total hip arthroplasty / 局解手术学杂志

Objective To analyze the long-term effect and prognosis of automatic angle measuring instrument in measuring anteversion angle of patients with total hip arthroplasty(THA).Methods A total of 120 patients with THA from June 2012 to January 2017 were divided into two groups by random number table,with 60 cases in each group.The anteversion angle of THA in control group was measured by CT, while the anteversion angle of THA in observation group was measured by automatic angle measuring instrument.The recovery of hip joint, score of living quality,incidence of complications before and after surgery were compared between the two groups. Results After surgery,the score of hip joint recovery in control group was lower than that in observation group,the difference was significant(P<0.05).After surgery, the scores of living quality in two groups increased compared with those before surgery,and the increased range of observation group was lar-ger,the difference was significant(P<0.05).The incidence of complications in control group was 13.33% ,which was higher than 1.67% of observation group,the difference was significant(P<0.05). Conclusion Automatic angle measuring instrument in measuring anteversion angle of THA can increase measuring accuracy,decrease the incidence of complications,increase living quality and promote prognosis,which is worthy of promotion in clinical application.

The therapeutic effects of total hip arthroplasty with combined anteversion angle of femoral neck-acetabu lam in Crowe Ⅳ developmental dysplasia of the hip / 实用医学杂志

Objective To evaluate the clinical efficacy of combined anteversion angle of femoral neck-acetabulam in Crowe Ⅳ developmental dysplasia of the hip (DDH) with Wagner Cone total hip arthroplasty. Methods From June 2013 to February 2016,45 cases of CroweⅣDDH were treated with no femoral shortening osteotomy in THA ,including 25 females and 20 males. The outcomes of anteversion angle of femoral neck and acetabulam were measured in CT scan of hip jiont. The outcomes of abduction angle ,hip center were measured radiologically in X-ray of pelvis. Postoperative function was scored by Harris scoring system. Results The mean follow-up time of the 45 patients was(3.2 ± 0.8)years. Using loosening or revision as the end point ,the survival rate was 100%. The outcomes of preoperative anteversion angle of acetabulam,femoral neck,acetabulam-femoral neck was(27.70 ± 5.35)°,(47.76 ± 7.25)°,and(74.90 ± 8.43)° in CroweⅣgroup,and those of postoperative anteversion angle was(19.82 ± 2.41)° ,(23.35 ± 3.84)° and(44.90 ± 5.18)° ,respectively. There was significant difference between the two groups(P < 0.05). The average height of preoperative dislocation in femoral head was (5.8 ± 1.2)cm and the postoperative average displacement of femoral lesser trochanter was (3.6 ± 0.8)cm. The Harris hip score was improved from preoperative(46.66 ± 7.28)to(90.36 ± 4.72). For most patients,hip pain were significantly relieved ,range of motion of the hip was improved ,and the gait returned to normal. Femoral nerve injury occurred in 2 cases and the case recovered after 3 months respectively. Conclusions The deformity of hip and the stability and matching degree of the prosthesis was evaluated with the combined anteversion angle of femoral neck-acetabulam in CroweⅣDDH. The Wagner Cone can effectively maintain the stability of the hip joint in the non-amputated total hip replacement.

Correlation Between Anteversion and neck-Shaft Femoral Angles, For Designing Of Hip Prostheses.

Background& Objective: Femoral neck anteversion angle (FNA) and neck-shaft angle (NSA) or inclination angle are important anatomic indicators in clinical orthopedics. Main aim of this study, is to determine correlation between FNA and NSA to prediction one of these parameters from other to designing of hip prostheses .Methods: Each femur was placed with the posterior surface of its condyles and greater trochanter touching a smooth horizontal surface (Kingsley and Olmsted method). For measurement of anteversion angle, Retrocondylar axis andfemoral neck axis were made with digital photography and with Digimizer software. For measurement of inclination angle, femoral neck axis and Diaphyseal axis were made with same manner. Results: 159 dried femora were studied. Average anteversion angle in degree for male was 12.17° (±6.83°) and in female was 15.14° (±9.17°). According to this study, in left male femur, for one degree increase in NSA, FNA grows 0.38°; in right male femur, for one degree increase in NSA, FNA grows 0.74°; in right female femur, for on degree increase in NSA, FNA grows 1.55°.Interpretation& Conclusion:In this research, we found that there is a meaningfulpositive relationship between FNA and NSA, to prediction on of them from the other. This relationship is seen in male femur (right and left) and Female femur (just right). [Ehsangolchini NJIRM 2016; 7(5): 25-32]

USE OF SMARTPHONE IN ACETABULAR COMPONENT ANGLE MEASUREMENT DURING TOTAL HIP ARTHROPLASTY / 中国修复重建外科杂志

OBJECTIVE: To evaluate the accuracy of using smartphone to measure the angle of acetabular component in total hip arthroplasty (THA). METHODS: Between June 2012 and September 2015, the acetabular abduction and anteversion angles were measured in 50 patients undergoing THA. There were 24 males and 26 females, aged 37 to 83 years (mean, 71 years). The left hip was involved in 22 cases and the right hip in 28 cases. Of 50 patients, 34 suffered from fracture of the femoral neck, and 16 suffered from avascular necrosis of the femoral head. Acetabular dysplasia was excluded in all cases. A smartphone was used to measure the acetabular abduction and anteversion angles during operation; standard Picture Archiving and Communication Systems (PACS) was used to measured the acetabular abduction and anteversion angles on the X-ray film at 1 week after operation. It was defined as positive that the component angle values by PACS measurement were greater than those by the smartphone measurement, whereas as negative. The two measurement methods were compared, and intra-observer variability was assessed by analyzing the intraclass correlation coefficient (ICC), the Mann-Whitney U-test was used to analyze difference. RESULTS: The ICC was 0.84 in the acetabular component angles by smartphone and PACS measurement methods. The acetabular component abduction angle was (44.02±1.33)° and the anteversion angle was (17.62±2.20)° by smartphone measurement. The acetabular component abduction angle was (44.74±4.05)° and the anteversion angle was (17.22±5.57)° by PACS measurement. There was no significant difference between two measurement methods (Z=-1.977, P=0.482; Z=-0.368, P=0.713). The acetabular component angle was in the safe zone in 44 cases; and the acetabular component anteversion angle was beyond safe range of 1 to 5°, and the abduction angle was beyond safe range of 1 to 3° in 6 cases. Intra-measurement variability was -21 to +10° for the anteversion angle and -10 to + 9° for the abduction angle, indicating that the acetabular component anteversion angle by smartphone measurement was greater than that by the PACS measurement, and the abduction angle was less than that by PACS measurement. CONCLUSIONS: Smartphone is a convenient tool to measure the acetabular component angle in THA.

Three-dimensional measurement of femoral neck anteversion / 中华创伤杂志

Objective To investigate the evaluation of femoral neck anteversion using the digital three-dimensional model induced determination method.Methods Ten healthy volunteers,including five men and five women,aged 18-60 years (mean,43 years) were recruited.Bilateral femur CT scan was taken and processed with Mimics 17.0 software to build the three-dimensional model of the femur.Traditional Photoshop and three-dimensional reconstruction techniques were separately applied to determine the femoral neck anteversion.Anteversion angle and measurement time determined with the two methods were compared.Results Anteversion angle was (17.0 ± 4.2) ° based on the Photoshop method and was (17.0 ± 4.2) ° based on the three-dimensional method (P ＞ 0.05).Measuring time was (1,231.5 ± 152.8) sec with the Photoshop method and (590.0 ± 37.2) sec with the three-dimensional method (P ＜ 0.01).Conclusion Both methods provide accurate measuring of the femoral neck anteversion,but three-dimensional measurement spends far less time resulting in improved measure efficiency.

Measurement of the femoral neck torsion angle and anteversion angle by laser projection method / 解剖学报

Objective To investigate the feasibility of measuring femoral neck torsion angle and anteversion angle by laser projection method .Methods The femoral neck torsion angle and anteversion were observed and described .An angle measuring device was designed and produced .With the device , the femoral torsion angle and anteversion angle were measured by laser projection method two times .Statistical analysis was performed on the measured value , and sides difference .Results The differences between femoral neck torsion angle and anteversion angle were observed .There was no significant difference ( P >0.05, power =100%) between the two measurements by laser projection method . Measurements of the femoral anteversion were 13.58 °±6.55 °on the left side , and 12.15 °±5.83 °on the right side . Measurements of the femoral neck torsion angle were 18.50 °±7.38 °on the left and 19.08 °±8.59 °on the right .There was no significant difference between left and right side ( P >0.05 ) .Conclusion The laser projection method is the effective method in measuring femoral neck torsion angle and anteversion angle , and has excellent repeatability .

Influence from acetabular component orientation on stress distributions of periacetabulum / 医用生物力学

Abstract： Objective To study the influence from different placement angles of acetabular component on inner and outer stress distributions of periacetabulum in acetabular reconstruction of total hip arthroplasty (THA), so as to explore proper orientation for improving stability of acetabular component after THA. Methods Based on model with inhomogeneous material property assignment, nine THA models with acetabular component at different anteversion angles(15°, 20°, 25°) and abduction angles(40°, 45°, 50°) as well as one normal hip model were constructed. The maximal hip contact force in phase of single leg stance during normal gait cycle was chosen as the loading condition. In addition, according to the qualitative and quantitative principle, inner and outer stress distributions on 9 THA models were analyzed and compared with the normal hip model as control. Results When abduction angle of acetabular component was the nearest to anatomic angle (19° anteversion, 46° abduction) of acetabulum, the phenomenon of stress shielding on periacetabulum was the most obvious. When abduction angle of acetabular component was placed at 45° and anteversion angle changed from 15° to 25°, no significant influence was exerted on the whole stress distributions of THA models. Meanwhile, when anteversion angle of acetabular component was 15°, the THA model had good stability in stress distributions, and the phenomenon of stress shielding on cortical and cancellous bone was obviously improved. Conclusions For patients who have normal anatomic acetabulum and need to be treated with THA, the abduction angle of acetabular component should be placed at 45°, as that of normal acetabulum; the anteversion angle should be 5° smaller than that of normal acetabulum and between 15° and 20°.

Hip surface replacement and total hip arthroplasty：Meta-analysis on the efficacy / 中国组织工程研究

10.3969/j.issn.2095-4344.2013.26.017

Influence of anteversion angles on stress distributions of the proximal femur after femoral neck fracture fixation: A finite element analysis / 医用生物力学

Objective To investigate the effects of different anteversion angles on stress distributions of the proximal femur after femoral neck fracture fixation by cannulated screw, and to provide biomechanical evidences for the importance of anatomical reduction in internal fixation in clinic. Methods Femoral neck fracture with Pauwells angle 70°was treated with cannulated screw internal fixation, and its three-dimensional finite element models with five different anteversion angles set at 0°，5°，10°，15°and 20°, respectively, were constructed based on normal human anatomical data from multi slice spiral CT as well as reverse engineering and CAD software. Loads were applied on each model to simulate normal walking status. Changes in stress distributions of the proximal femur in each model were observed. Results When the anteversion angle was 10°, the stress, displacement and equivalent strain of the femur was were the minimum, as the maximum stress of the proximal femur was 1.7 MPa, and the displacement was 1.1 mm. With the anteversion angle increasing or decreasing, the effective stress and displacement of the proximal femur was gradually increasing. When the anteversion angle was 20°, the stress of on the proximal femur and on the cannulated screw was became the maximum. When the anteversion angle was 0°, the displacement and equivalent strain of the femur also became the maximum. The stress concentration site of the femoral neck was gradually transferred from the inside rear to the outer top of the head and neck junction. The three cannulated screws there stood the higher stress than the surrounding bone tissues, and with the bottom screw stood the higher stress than the other top two screws. Conclusions Anatomic reduction is essential for femoral neck fracture fixation treated by cannulated screw. Changes in biomechanical factors after femoral neck fracture may play an important role in postoperative femoral head necrosis.

Femoral Neck Anteversion Measured Using a 3D CT Scan Perpendicular to the Mechanical Axis of the Femur

PURPOSE: We wanted to measure the femoral neck anteversion (FNA) angles using a 3D CT scan that perpendicularly cut the mechanical axis of the femur and to assess the accuracy and reproducibility of different measuring methods. MATERIALS AND METHODS: We obtained 95 cases of 3D CT images of the cross-section perpendicular to the mechanical axis of the femur. The methods used to measure the FNA angles included a method using the CT image of the area where the femoral neck is confluent to the greater trochanter (method 1), a method using the CT image taken from the neck base immediately prior to the beginning of the area of the lesser trochanter (method 2) and a method by which measurements are made after putting 3D bone models on a horizontal plane in virtual space (method 3). The reference axes of the distal femur we used were the anatomical transepicondylar axis, the surgical transepicondylar axis and the real posterior condylar axis. RESULTS: The FNA angles measured by method 1 were 4.79+/-6.41degrees to the anatomical transepicondylar axis (ATEA), 6.09+/-6.58degrees to the surgical transepicondylar axis (STEA) and 7.96+/-6.81degrees to the real posterior condylar axis (rPCA). The FNA angles measured by method 2 were 16.01+/-8.31degrees to the ATEA, 19.52+/-8.38degrees to the STEA and 21.79+/-8.52degrees to the rPCA. The FNA angles measured by method 3 were 20.15+/-12.89degrees to the rPCA. CONCLUSION: The measurement of the FNA angle using a 3D CT scan perpendicular to the mechanical axis is reproducible. The measurement method on the neck base level is more reliable than the one on the proximal neck confluence, and more similar to the measurement method by classic definition.