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OBJECTIVE@#To explore the related factors of femoral stem anteversion (FSA) after total hip arthroplasty (THA), so as to provide reference for clinical design of FSA before operation and reduce the risk of hip dislocation after arthroplasty.@*METHODS@#Ninty-three patients (103 hips) who underwent THA between October 2021 and September 2022 and met the selection criteria were selected as the study subjects. Among them, there were 48 males and 45 females with an average age of 58.5 years (range, 25-88 years). Body mass index was 18.00-37.84 kg/m 2, with an average of 24.92 kg/m 2. There were 51 cases (57 hips) of osteonecrosis of femoral head, 35 cases (39 hips) of hip osteoarthritis, and 7 cases (7 hips) of congenital hip dysplasia. Based on CT images, the following indicators were measured: preoperative femoral neck anteversion (FNA), preoperative femoral rotation angle (FRA), preoperative acetabular anteversion (AA), and preoperative combined anteversion (CA; the sum of preoperative FNA and AA); postoperative FSA and the change in femoral anteversion angle (the difference between postoperative FSA and preoperative FNA). Based on preoperative X-ray films, the following indicators were measured: femoral cortical thickness index (CTI) and canal flare index (CFI), the proximal femoral medullary cavity was classified according to Noble classification (champagne cup type, normal type, chimney type), neck-shaft angle (NSA), and femoral offset (FO). Pearson correlation analysis, one-way ANOVA, and Point-biserial correlation analysis were used to investigate the correlation between postoperative FSA, postoperative change in femoral anteversion angle, and patient diagnosis, proximal femoral medullary cavity anatomy type, gender, age, as well as preoperative FNA, FRA, AA, CA, NSA, FO, CTI, and CFI. FSA was used as the dependent variable and the independent variables that may be related to it were included for multiple linear regression analysis.@*RESULTS@#Based on CT image measurement, preoperative FNA was (15.96±10.01)°, FRA (3.36±10.87)°, AA (12.94±8.83)°, CA (28.9±12.6)°, postoperative FSA (16.18±11.01)°, and postoperative change in femoral anteversion angle was (0.22±9.98)°. Based on preoperative X-ray films measurements, the CTI was 0.586±0.081; the CFI was 4.135±1.125, with 23 hips classified as champagne cup type, 68 hips as normal type, and 12 hips as chimney type in the proximal femoral medullary cavity anatomy; NSA was (132.87±7.83)°; FO was (40.53±10.11) mm. There was no significant difference between preoperative FNA and postoperative FSA ( t=-0.227, P=0.821). Pearson correlation analysis showed that postoperative FSA was positively correlated with preoperative FNA, preoperative CA, postoperative change in femoral anteversion angle, and age ( P<0.05), while negatively correlated with preoperative FRA ( P<0.05). The postoperative change in femoral anteversion angle were positively correlated with preoperative FRA and postoperative FSA ( P<0.05), and negatively correlated with preoperative CA and FNA ( P<0.05). One-way ANOVA analysis showed that the above two indicators were not correlated with diagnosis and the proximal femoral medullary cavity anatomy type ( P>0.05). Multiple linear regression analysis showed a linear correlation between FSA and FNA, CA, age, and FRA ( F=10.998, P<0.001), and the best fit model was FSA=0.48×FNA-2.551.@*CONCLUSION@#The factors related to FSA after THA include patient's age, preoperative FNA, CA, FRA and postoperative femoral anteversion, of which preoperative FNA is the most closely related. When designing a surgical plan before surgery, attention should be paid to the patient's preoperative FNA, and if necessary, CT around the hip joint should be scanned to gain a detailed understanding of the proximal femoral anatomical structure.
Subject(s)
Female , Male , Humans , Middle Aged , Arthroplasty, Replacement, Hip , Femur/diagnostic imaging , Femur Neck , Femur Head , Hip JointABSTRACT
OBJECTIVE@#To explore the method and accuracy of measuring the femoral neck anteversion in children with developmental dislocation of the hip by using 3D printing technology, so as to find out the method of measuring the femoral neck anteversion accurately and guide the formulation of the operation plan.@*METHODS@#From June 2016 to September 2018, 17 patients with unilateral developmental dislocation of the hip were enrolled in the study, including 2 males and 15 females, aged 2 to 13 (5.47±0.81) years old, 11 on the left and 6 on the right. The methods of CT, 3D printing and intraoperative anteversion of femoral neck were used to measure the anteversion of femoral neck respectively. The intraoperative measurement was used as the standard reference value forstatistical analysis, and the accuracy of the first two methods was compared.@*RESULTS@#The average value of CT was (36.00±1.66)°, the average value of model method was(43.91±1.62)°, and the average value of intraoperative method was(44.21±1.62)°. There were significant differences in CT measurement, model measurement and intraoperative measurement(0.05).@*CONCLUSION@#Compared with the traditional CT method, the 3D printing model method is simpler, more accurate and more repeatable, and can simulate the operation before operation. It is an ideal method to measure the femoral neck anteversion.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Arthroplasty, Replacement, Hip , Femur , Femur Neck , Printing, Three-Dimensional , Tomography, X-Ray ComputedABSTRACT
Background: The femoral neck anteversion (FNA) also known as femoral torsion can be defined as the angleformed by the femoral condylar plane and a plane passing through the centre of the femoral neck and head. Thechange in the angle of femoral anteversion is associated with various clinical conditions. The data establishedin this study will be useful for various orthopedic procedures like arthroplasties, evaluation of pathologicconditions of the hip.Aim: To measure the angle of anteversion of femoral neck and determine the variation of this angle on both thesides.Materials and Methods: 90 dry femora 45 right and 45 left devoid of any gross pathology were obtained from thedepartment of anatomy, M S Ramaiah Medical College. The angle of femoral neck torsion was measured usinggoniometer in 90 dry bones were measured by Kingsley Olmsted method. The results obtained were tabulatedand statistically analyzed.Results: The mean femoral neck anteversion angle for right femur was 12.09° ± 4.56°, and for left femur it was12.53° ± 3.28°. Statistical analysis revealed the difference of means of FNA angle between the right and leftfemora was statistically non significant (p=0.65). Femoral anterversion was observed in 72.22% of bones while27.77% bones showed retroversion.Conclusion: The morphology of proximal end of femur is of special interest because of susceptibility of this areato numerous disorders in adults and in paediatric age group and the treatment needs a detailed anatomicalknowledge of angle of femoral neck torsion.
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Objective To discuss application of femoral neck anteversion′s correction in the treatment of children′s developmen-tal dysplasia of the hip .Methods 98 children diagnosed DDH from Jan 2006 to Jan 2010 were treated and followed up ranging from 12 to 48 months ,average 32 months .Before the operations ,FNA index were evaluated by X-ray and thin slice hip joint scan and 3D reconstruction to guide the rotary osteotomy .After the operations ,FNA index were rechecked .Results According to Mckay′s clas-sification ,clinical assessment was performed .84 hips were evaluated as excellent (73 .68% ) ,20 hips as good(17 .55% ) ,10 hips as acceptable(8 .77% ) ,and no poor hip (0% ) was reported .FNA decreased averagely 16 .3° ± 2 .0° .FNA had significant difference with themselves before the operations(P0 .05) .Conclusion The change of FNA is one of the most important pathological changes .FNA′s correction is one of the most valuable to guarantee success operation .
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Background: The femur is thighbone. The angle of femoral torsion is the angle obtaining between the transverse axes of the neck and head that of the lower end of the bone. In the adult, the angle measures about 12 to 15 degrees, but it is considerably greater in the fetus and at birth averages 40 degrees. In postnatal development a reduction of the FNA angle usually occurs during growth. Aim: to evaluate femoral torsion value on dried femora and to find the difference between Japanese, Caucasian and Indian femoral torsion. Method: The present study was carried out on 200 dry normal adult human femora. The bones studied were free of any pathological condition. The male bones were 117 and 83 were female femora out of 200 dried femora. Out of 111 were left and 89 were right femora. The gender of each specimen was determined by the recognized established practice. The angle of anteversion as measured by placing the femur on the osteometric board, the horizontal surface represents the retrocondylar axis and the plane of reference against which the anteversion is measured with the help of the axis of head and neck of the femur. Results: The average anteversion is 16.1 and 15.65 on the right and left sides respectively in male, 18.17 and 17.95 on the right and left sides respectively in female. Statistical analysis using ‘z’ test revealed significant (p<0.05), greater average anteversion in female bones and right-left variations, being greater on the right side. Conclusion: The objective measurement of this angle is of paramount importance in orthopedic surgery for total replacement to attain a normal activity of the replaced joint.
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The purpose of this study was to estimate the average angle of femoral neck anteversion in an Indian population. Unpaired 92 dry femurs, 50 of female (27 right and 23 left) and 42 of male (22 right and 20 left) devoid of any gross pathology were used to measure the femoral neck angle (FNA) from Department of Anatomy, Govt. Medical College, Bhavnagar in year 2005. They were evaluated by the Kingsley Olmsted method, and the data were statistically analyzed. In female femoral neck anteversion range form –8.3° to +30.4º with a mean of 16.4º on left and 10.5º on right sides. In male femoral neck anteversion range from –13.7° to +25.6º with a mean of 14.3º on right and 7.2º on left sides. The female femora showed about 2.7° more anteversion than the male femora. The average left-sided femora showed about 6.4° more anteversion than the right-sided femora.
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Objective To evaluate the femoral neck anteversion (FNA) of patients with unilateral developmental dysplasia of the hip (DDH) and reveal the developmental regularity of the proximal femur.Methods 366 three-dimensional CTs of unilateral DDH patients were categorized into three age groups:＜18 months, 18 months-3 years,and＞3 years.The femoral neck anteversion of both sides were measured and a statistical comparison was performed between them.The line chart showing the relationship of femoral neck anteversion and age was drawn to reveal the developmental regularity of the proximal femur.Results In total,the affected side of unilateral DDH had an femoral neck anteversion 1°～5° significantly larger than the unaffected side (P＜0.05).There was no statistical difference between affected and unaffeted sides in age group＜18 months and 18 months-3 years,while it was significant in age group＞3 years.Conclusion Pathological changes of the proximal femur were observed not only the affected side in unilateral DDH but also the unaffected side.The FNA symmetrically developed with age older.
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Objective To discuss the femoral neck anteversion(FNA) of developmental dislocation of the hip(DDH) and guide operation with visual and digitalized picture in the dimensional(3D) CT.Methods Ninety children with unilateral DDH were selected,and they were analyzed using 3D CT.Children whose FNA exceed 45 degree received the subtrochanter osteotomy with images from different direction,FNA of hip was measured respectively before and after operation and was measured in normal and abnormal hips respectively,FNA of hip received respectively statistical treatment.Ninety patients (90 hips) were followed up ranging from 3 months to 2 years with the mean of 13 months.Results In the group younger than 18 months,the FNA whose in normal hips was(19.40?3.512)degree,the FNA while(68.45?12.272)degree in dysplasia hips respectively,the FNA measured after operation was (20.45?2.940) degree;in the group elder than 6 years,there were significantly statistical differences,the FNA in normal hips was(19.44?3.561)degree,in dysplasia hips respectively was(73.49?12.678)degree,while the FNA measured after operation was(18.28?1.931)degree.Clinical assessment was performed according to Mckay′s classification.The results showed that the overall excellent or good rate was 95.6%.Conclusions 3D CT method is a new accurate and convenient and reduplicative method for measuring FNA.It will be more helpful for related operations when 3D images are considered.
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Objective To evaluate the value of reconstruction of three-dimentional CT in development dislocation of hip(DDH)in children.Methods Twelve cases of DDH concluded 4 bilateral and 8 unilateral cases.To sum up,16 sick hips were operated and 8 normal hips were also obtained by three-dimensional CT(Hip speed Fi/x,GE Co).Results 3D reconstruction were used to show femoral head,(acetabulum) and relationship of acetabulum and femoral head respectively.The difference between FNA measurement of sick hips and those of normal hips were significant(P