Locating the Origin of Femoral Maltorsion Using 3D Volumetric Technology—The Hockey Stick Theory

Background: The origin of femoral maltorsion is often unknown. However, defining the origin of the rotation of the femoral maltorsion can be useful for establishing the most suitable point to do an external derotational osteotomy. Previous studies have not considered the femoral diaphysis in their investigations of the origin of the deformity. The study of the whole morphology of the femur with 3D volumetric tools, including the femoral diaphysis can contribute to a better understanding of the behavior of femoral maltorsion. Methods: An atypical case of unilateral femoral anteversion was selected. Both femurs were used to obtain 3D bio-models. The mirror image of the asymptomatic side was obtained and overlapped with the symptomatic femur. The Hausdorff–Besicovitch method was used to evaluate the morphologic discrepancies (in mm) between the two femurs in three zones: (1) the femoral neck, (2) the proximal diaphysis, and (3) the distal diaphysis. The differences between the two femurs were analyzed and its correlation was statistically defined using a lineal regression model. Results: The deformity in the distal diaphysis increased from the supracondylar area until the apex of the antecurvatum angle (R2 = 0.91) and then decreased until the base of the femoral neck (R2 = (−0.83)), to finally increase significantly in the femoral neck area (R2 = 0.87). All of the correlations were statistically significant (p-value ˂ 0.001). Conclusion: The femoral maltorsion originates in the supracondylar area and its rotational axis is the longitudinal axis of the femoral diaphysis. Even though the deformity affects the femoral diaphysis, its clinical relevance is much higher in the femoral neck since the rotational axis passes through its base. Thus, the osteotomy can be conducted along all of the femoral diaphysis as long as it is done perpendicular to it.

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The walls of the femoral neck as an auxiliary tool for femoral stem positioning

Hip International ◽

10.1177/11207000211040763 ◽

2021 ◽

pp. 112070002110407

Author(s):

Samuel Morgan ◽

Ofer Sadovnic ◽

Moshe Iluz ◽

Simon Garceau ◽

Nisan Amzallag ◽

...

Keyword(s):

Femoral Neck ◽

Accurate Determination ◽

Femoral Stem ◽

Posterior Wall ◽

Anterior Wall ◽

Femoral Anteversion ◽

Lower Limbs ◽

Imaging Analysis ◽

Femoral Condyles

Background: Femoral anteversion is a major contributor to functionality of the hip joint and is implicated in many joint pathologies. Accurate determination of component version intraoperatively is a technically challenging process that relies on the visual estimation of the surgeon. The following study aimed to examine whether the walls of the femoral neck can be used as appropriate landmarks to ensure appropriate femoral prosthesis version intraoperatively. Methods: We conducted a retrospective study based on 32 patients (64 hips) admitted to our centre between July and September 2020 who had undergone a CT scan of their lower limbs. Through radiological imaging analysis, the following measurements were performed bilaterally for each patient: anterior wall version, posterior wall version, and mid-neck femoral version. Anterior and posterior wall version were compared and evaluated relative to mid-neck version, which represented the true version value. Results: Mean anterior wall anteversion was 20° (95% CI, 17.6–22.8°) and mean posterior wall anteversion was −12° (95% CI, −15 to −9.7°). The anterior walls of the femoral neck had a constant of −7 and a coefficient of 0.9 (95% CI, −9.8 to −4.2; p < 0.0001; R2 0.77). The posterior walls of the femoral neck had a constant of 20 and a coefficient of 0.7 (95% CI, 17.8–22.5; p < 0.0001; R2 0.60). Conclusions: Surgeons can accurately obtain femoral anteversion by subtracting 7° from the angle taken between the anterior wall and the posterior femoral condyles or by adding 20° to the angle taken between the posterior wall and the posterior femoral condyles.

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Femoral Neck-shaft Angle Differs but Femoral Anteversion is Constant in Osteological Specimens with and without a Cam Deformity of the Proximal Femur

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2013.09.051 ◽

2013 ◽

Vol 29 (12) ◽

pp. e207 ◽

Cited By ~ 1

Author(s):

Jonathan Streit ◽

Jeremy Gebhart ◽

Asheesh Bedi ◽

Charles Bush-Joseph ◽

Shane Nho ◽

...

Keyword(s):

Femoral Neck ◽

Proximal Femur ◽

Femoral Anteversion ◽

Neck Shaft Angle ◽

Cam Deformity ◽

Shaft Angle

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Distal femoral derotational osteotomy with external fixation for correction of excessive femoral anteversion in patients with cerebral palsy

Journal of Pediatric Orthopaedics B ◽

10.1097/bpb.0000000000000168 ◽

2015 ◽

Vol 24 (5) ◽

pp. 425-432 ◽

Cited By ~ 7

Author(s):

Eyad Skiak ◽

Ahmet Karakasli ◽

Onur Basci ◽

Ismail S. Satoglu ◽

Fatih Ertem ◽

...

Keyword(s):

Cerebral Palsy ◽

External Fixation ◽

Femoral Anteversion ◽

Derotational Osteotomy

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Sex Difference in Hip Adduction during Running: Influence of Hip Abductor Strength, Activation, and Pelvis & Femur Morphology

10.31236/osf.io/cfvzu ◽

2021 ◽

Author(s):

Jia Liu ◽

Kristi L. Lewton ◽

Patrick M. Colletti ◽

Christopher M. Powers

Keyword(s):

Sex Differences ◽

Femoral Neck ◽

Muscle Activation ◽

Femoral Anteversion ◽

Femur Length ◽

Computed Tomography Scanning ◽

Hip Abductor ◽

Independent Variable ◽

Tomography Scanning ◽

Abductor Strength

Purpose: To examine the influence of hip abductor strength, neuromuscular activation, and pelvis & femur morphology in contributing to sex differences in hip adduction during running.Methods: Fifteen female and 14 male runners underwent strength testing, instrumented overground running (e.g., kinematics and muscle activation), and computed tomography scanning of pelvis and femur. Morphologic measurements included bilateral hip width to femur length ratio, acetabulum abduction, acetabulum anteversion, femoral anteversion, and femoral neck-shaft angles. Sex differences for all variables were examined using independent t-tests. Linear regression was used to assess the ability of each independent variable of interest to predict peak hip adduction during the late swing and stance phase of running. Results: Compared to males, females exhibited significantly greater peak hip adduction during both late swing (8.5 ± 2.6° vs 6.2 ± 2.8°, p = 0.04) and stance phases of running (13.4 ± 4.2° vs 10.0 ± 3.2°, p = 0.02). In addition, females exhibited significantly lower hip abductor strength (1.8 ± 0.3 vs 2.0 ± 0.3 Nm/kg, p=0.04), greater femoral neck-shaft angles (134.1 ± 5.0° vs 129.9 ± 4.1°, p=0.01), and greater hip width to femur length ratios than males (0.44 ± 0.02 vs 0.42 ± 0.03, p=0.03). Femoral anteversion was the only significant predictor of peak hip adduction during late swing (r=0.36, p=0.05) and stance (r=0.41, p=0.03).Conclusion: Our findings highlight the contribution of femur morphology as opposed to hip abductor strength and activation in contributing to hip adduction during running.

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INTRACAPSULAR FEMORAL NECK FRACTURES

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.09.60 ◽

2018 ◽

Vol 25 (09) ◽

pp. 1317-1322

Author(s):

Muhammad Jawad Ahmed ◽

Maryam Shahid ◽

Muhammad Hammad Ahmed ◽

Bilal Nazarq

Keyword(s):

Femoral Neck ◽

Functional Outcome ◽

Femoral Neck Fractures ◽

Outcome Variable ◽

P Value ◽

Bipolar Hemiarthroplasty ◽

Chi Square ◽

Neck Of Femur ◽

Chi Square Test ◽

Walking Aid

Objectives: To compare of functional outcomes in terms of post-operativemobility for unipolar versus bipolar un-cemented hemiarthroplasty in elderly patients withdisplaced intracapsular femoral neck fractures. Study Design: Randomized Control Trial.Setting: Department of Orthopedics Bahawal Victoria Hospital, Bahawalpur. Period: April 2015to October 2016. Methodology: Sample size is (calculated by taking n6 =138, confidenceinterval 95, power of study 80, P1= 33%, P2=13%) 69 in each group. Sampling technique usedwas non probability consecutive sampling. All patients who meet the inclusion criteria presentingto orthopedic unit of Nishtar Hospital Multan with fracture neck of femur were selected for study.Patients were divided into two groups randomly by lottery method and enrolled for unipolaror bipolar hemiarthroplasty. Chi-square test was used to compare outcome variable in bothgroups. A p-value < 0.05 was considered statistically significant. Effect modifiers like age andsex was controlled by stratification. Chi square test was applied to see significant difference.Results: Overall, there were 100% (n=138) patients in this study, both genders. The mean ageof the patients was 66.35±4.29 years. (Range: 60 to 80years)Mean age and SD of group A (nowalking aid) was 54.52 ± 3.10 and in group B (walking aid) 54.99 ± 3.19. Time up go score wasnoted as successful 33.3% (n=46) and 66.7% (n=92) as unsuccessful. Walking aid was notedin 65.2% (n=90) patients. Functional outcome was noted as good in 26.8% (n=37) patientsand noted as bad in 73.2% (n=101) patients. Out of 100% (n=38) patients, good outcomewas 26.3% (n=10) unipolar and 73.7% (n=28) bipolar. Out of 100% (n=100) Bad outcomewas 59% unipolar and bipolar 41%. Conclusion: Functional outcome in term of mobility isbetter in case of bipolar prosthesis as compared to unipolar. Thus in our conclusion bipolarprosthesis is preferred procedure as compared to unipolar hemiarthroplasty in treating patientswith displaced intracapsular femoral neck fracture.

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CT Measurement of Anteversion in the Femoral Neck

Acta Radiologica ◽

10.1080/02841859709174381 ◽

1997 ◽

Vol 38 (4) ◽

pp. 527-532 ◽

Cited By ~ 7

Author(s):

K. L. Hermann ◽

N. Egund

Keyword(s):

Clinical Practice ◽

Femoral Neck ◽

Measurement Accuracy ◽

Femoral Shaft ◽

Femoral Anteversion ◽

Intraobserver Variability ◽

Actual Position ◽

Measurement Concept ◽

The Mean ◽

Ct Measurement

Purpose: To evaluate CT methods of measuring anteversion in the femoral neck with respect to measurement accuracy and with respect to the influence exerted by different femoral shaft positions; and to describe a new CT measurement concept that introduces a mathematical adjustment for different femoral shaft positions. The new technique facilitates the taking of measurements in patients who cannot be correctly positioned in traditional methods. Material and Methods: CT examinations of previously measured anteversions in the femoral neck were reviewed in retrospect in 30 patients with fractures of the femoral neck. The position of the femoral shaft was assessed. A reference angle was compared with direct traditional measurements and with measurements adjusted for the actual position of the femoral shaft by means of a 3D mathematical reconstruction. Reproducibility and inter— and intraobserver variability were assessed in 10 cases. Results: All femurs varied in position within the gantry. The mean difference between the direct CT measurement and the adjusted CT measurement compared to the reference angle were -8.8° (range -35.0-16.3°) and -0.1° (range -1.4-1.4°), respectively. For the adjusted CT method, reproducibility and inter- and intraobserver variability were 1.4 intraobserver variability were 1.4, 1.6 intraobserver variability were 1.4 and 1.4° (SD of difference), respectively. Conclusion: CT measurement of femoral anteversion in clinical practice can only be accurate when corrected for variation in the position of the femoral shaft.

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Uncemented total hip arthroplasty with subtrochanteric derotational osteotomy for severe femoral anteversion

The Journal of Arthroplasty ◽

10.1016/s0883-5403(99)90223-1 ◽

1999 ◽

Vol 14 (6) ◽

pp. 682-688 ◽

Cited By ~ 22

Author(s):

Hamid G. Zadeh ◽

Jia Hua ◽

Peter S. Walker ◽

Sarah K. Muirhead-Allwood

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Anteversion ◽

Total Hip ◽

Derotational Osteotomy ◽

Uncemented Total Hip Arthroplasty

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Total Hip Arthroplasty (THA) for Femoral Neck Fractures: Comparison between Standard and Dual Mobility Implants

Geriatrics ◽

10.3390/geriatrics6030070 ◽

2021 ◽

Vol 6 (3) ◽

pp. 70

Author(s):

Riccardo L. Alberio ◽

Mattia Rusconi ◽

Loris Martinetti ◽

Diego Monzeglio ◽

Federico A. Grassi

Keyword(s):

Femoral Neck ◽

Older Patients ◽

Womac Score ◽

Femoral Neck Fractures ◽

Radiographic Evaluation ◽

P Value ◽

Short Term ◽

Dual Mobility ◽

Clinical Records ◽

Clinical And Radiological Results

The purpose of this retrospective study is to compare the short-term clinical and radiological results between standard and dual mobility THA for femoral neck fractures (FNF) in older patients. The hypothesis is that the dual mobility cup (DMC) has the same outcomes but a lower dislocation rate than the standard THA. The study population included 56 patients (mean age 77.7 years, range 71–85) that underwent THA for displaced FNF. Patients were divided in two comparable groups for baseline characteristics (age, sex and comorbidities): 28 patients underwent THA with a standard cup (SC) and 28 THA with DMCs. The clinical records and radiograms were reviewed to search relevant data in their postoperative history. Two postoperative dislocations occurred in the SC group and none in the DMC group. At an average follow up of 23 months (12–40), 48 patients were available for the final evaluation. The WOMAC score for all patients averaged 6.26 (0–46) and was slightly better in the DMC group (4.94 vs. 7.58; p-value = 0.41); scores were significantly better in presence of neurological comorbidities (p-value = 0.04), in the absence of diabetes (p-value = 0.04) and in the case of psychiatric disorders (p-value = 0.02). Radiographic evaluation at one year showed signs of osteointegration in 42/48 (87.5%) acetabular components (20 DMCs, 22 SC). According to our experience, DMCs proved to be a valid option for the treatment of displaced FNF in older patients, since it allowed them to achieve short-term outcomes comparable to conventional THA, while decreasing the incidence of postoperative dislocations.

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Computed tomographic evaluation of femoral and tibial conformation in English Staffordshire Bull Terriers with and without congenital medial patellar luxation

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-16-12-0162 ◽

2017 ◽

Vol 30 (03) ◽

pp. 191-199 ◽

Cited By ~ 4

Author(s):

Katja Voss ◽

Mark Newman

Keyword(s):

Computed Tomography ◽

Clinical Decision Making ◽

External Rotation ◽

Femoral Condyle ◽

Clinical Decision ◽

Femoral Anteversion ◽

Femoral Diaphysis ◽

Control Group ◽

Anteversion Angle ◽

Tibial Valgus

SummaryObjective: To compare hindlimb conformation of English Staffordshire Bull Terriers with and without medial patellar luxation using computed tomography.Methods: Hindlimb computed tomography (CT) was performed on six English Staffordshire Bull Terriers with grade II or III medial patellar luxation, and six without medial patellar luxation. Inclination angle, femoral condyle trochanteric angle, anteversion angle (AA), distal anteversion angle (DAA), proximal anteversion angle (PAA), femoral varus angle (FVA), tibial valgus angle (TVA), and tibial torsion angle (TTA) were measured. Student’s T-test was conducted to compare normal limbs to limbs with medial patellar luxation, all limbs of dogs with medial patellar luxation to limbs of the control group, and medial patellar luxation affected limbs (normal limbs of unilaterally affected dogs excluded) to the control group. P-values less than 0.05 were considered significant.Results: Two dogs with medial patellar luxation were only affected unilaterally. Limbs of English Staffordshire Bull Terriers with medial patellar luxation had significantly diminished AA and DAA, in addition to decreased TVA. These differences were similar regardless of how the unaffected limbs from affected dogs were treated in our analysis.Discussion and conclusion: Medial patellar luxation in this population of English Staffordshire Bull Terriers was characterized by a decrease in femoral anteversion, external rotation of the femoral diaphysis, and decreased tibial valgus. These findings may help inform clinical decision making when performing osteotomy for treatment of medial patellar luxation in this breed.

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