Femoral Offset and its Relationship to Femoral Neck-shaft Angle and Torsion Angle

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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Radiographic analysis of the proximal femoral anatomy in the Croatian population

International Orthopaedics ◽

10.1007/s00264-021-04942-5 ◽

2021 ◽

Author(s):

Hrvoje Mokrovic ◽

Simona Komen ◽

Leo Gulan ◽

Gordan Gulan

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Radiographic Evaluation ◽

Neck Length ◽

Femoral Offset ◽

Head Diameter ◽

Neck Shaft Angle ◽

Femoral Neck Anteversion ◽

Femoral Head Diameter ◽

Shaft Angle

Abstract Purpose The goal of total hip endoprosthesis is to achieve painless and functional hip for long term. Accurate reconstruction of hip anatomy largely depends on the implant design. In order to select an implant in correspondence with the native hip, the proximal femoral morphology has been in focus of many studies in the past years. The purpose of this study is to analyze proximal femoral geometry in the Croatian population by radiographic evaluation. Methods We conducted a retrospective study analyzing conventional radiographies of the hip, obtained within the last four years from the database of Clinic for Orthopaedic Surgery Lovran. The number of studied patients was 300,168 women and 132 men. The proximal femoral geometric parameters assessed were as follows: femoral head diameter, femoral neck length, neck-shaft angle, angle of femoral neck anteversion, and lateral femoral offset. The results obtained were compared between genders and with results of other studies. Results Proximal femoral anatomy differed in femoral head diameter and lateral femoral offset between males and females in our group of patients, while femoral neck length, femoral neck shaft angle, and femoral neck anteversion have shown similar values in both genders. Our study also showed specificity of the Croatian population in almost all parameters of proximal femoral anatomy, in comparison with other ethnic groups. Conclusion Our results support the observation on high diversity in the morphology of the proximal femur and the specificity of the proximal femoral anatomy of the Croatian population.

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Which factors influence proximal femoral asymmetry?

The Bone & Joint Journal ◽

10.1302/0301-620x.100b7.bjj-2017-1601.r1 ◽

2018 ◽

Vol 100-B (7) ◽

pp. 839-844 ◽

Cited By ~ 11

Author(s):

P. Laumonerie ◽

M. Ollivier ◽

S. LiArno ◽

A. Faizan ◽

E. Cavaignac ◽

...

Keyword(s):

Femoral Neck ◽

Demographic Parameters ◽

Healthy Individuals ◽

Femoral Offset ◽

Neck Shaft Angle ◽

Significant Relationships ◽

Shaft Angle ◽

Flare Index ◽

And Gender ◽

Anatomical Restoration

AimsIn patients where the proximal femur shows gross deformity due to degenerative changes or fracture, the contralateral femur is often used to perform preoperative templating for hip arthroplasty. However, femurs may not be symmetrical: the aim of this study was to determine the degree of variation between hips in healthy individuals and to determine whether it is affected by demographic parameters.Materials and MethodsCT-scan based modelling was used to examine the pelvis and bilateral femurs of 345 patients (211 males, 134 women; mean age 62 years (standard deviation (sd) 17), mean body mass index 27 kg/m2(sd 5)) representing a range of ethnicities. The femoral neck-shaft angle (NSA), femoral offset (FO), femoral neck version (FNV), femoral length (FL), femoral canal flare index (fCFI), and femoral head radius (FHr) were then determined for each patient. All measurements were constructed using algorithm-calculated landmarks, resulting in reproducible and consistent constructs for each specimen. We then analyzed femoral symmetry based on absolute differences (AD) and percentage asymmetry (%AS) following a previously validated method.ResultsWe found an asymmetry > 2% for NSA (mean AD 2.9°, mean %AS 2.3; p = 0.03), FO (AD 3.8 mm, %AS 9.1 ; p = 0.01), FNV (AD 5.1°, %AS 46.7 ; p = 0.001) and fCFI (AD 0.2 mm, %AS 5.4 ; p = 0.7). Significant relationships were found for AD regarding NSA and ethnicity (p = 0.037), FL and height (R2 = 0.22), and fCFI and gender (R2 = 0.34).ConclusionOur data confirm the presence of asymmetry of proximal femurs, which is mostly independent of demographic parameters. In cases where contralateral templating is used, such asymmetry may lead to inaccurate anatomical restoration of the hip if the templated sizes are routinely implanted. However, the clinical impact cannot be determined from our investigation. Cite this article: Bone Joint J 2018;100-B:839–44.

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Radiographic Assessment of the Proximal Femoral Anatomy in An Indigenous African Adult Population

International Journal of Anatomy and Research ◽

10.16965/ijar.2021.140 ◽

2021 ◽

Vol 9 (3.1) ◽

pp. 8034-8039

Keyword(s):

Femoral Neck ◽

Proximal Femur ◽

Adult Population ◽

Femoral Offset ◽

Femoral Neck Axis ◽

Neck Shaft Angle ◽

Shaft Angle ◽

The Mean ◽

Axis Length ◽

Neck Diameter

Background: Hip surgeries such as fracture fixation, corrective osteotomy, hemiarthroplasty, or total hip arthroplasty require accurate preoperative templating for a successful outcome. Such templating is done using the proximal femur and the acetabulum radiographs, depending on the planned surgery. Understanding the normal radiographic anatomy of the proximal femur is crucial to differentiate a normal from pathological anatomy. Proximal femoral anatomic indices include the femoral head diameter, femoral neck diameter, femoral neck length, femoral offset, femoral neck axis length and the femoral neck-shaft angle. Aim: This study assesses and establishes the average values of the proximal femoral anatomy in an indigenous African adult population. Method: This cross-sectional study examined 190 normal anteroposterior (AP) radiographs of the pelvis. The mean age, weight and height of the subjects were obtained. The following proximal femoral anatomic parameters were measured: femoral neck length (FNL), femoral neck diameter (FND), femoral head diameter (FHD), femoral neck-shaft angle (FNSA), femoral offset (FO) and femoral neck axis length (FNAL). The authors compared the mean difference of the parameters between the genders and the age categories and assessed the parameter correlations with the patients’ weight and height. Results: Males constituted 63 (33.2%) of the study population. The mean age of the subjects was 51.46 years (SD = 16.37). The mean weight was 76.13 kg, while the mean height was 1.62 m. The mean values of the proximal femoral parameters were as follows: FNL 4.52cm, FND 3.42cm, FHD 4.76cm, FNSA 132.960, FO 4.09cm, and FNAL 10.34cm. Males have a significantly higher mean value in all the parameters except the FO. None of the parameters showed any significant difference among the age categories except the FNL. A post-hoc analysis showed that the difference in the FNL lies between the young and the elderly age groups. The subjects’ height correlated with all the parameters except FNSA, while the weight correlated with the FND, FNSA and FNAL. Conclusion: The proximal femoral anatomy in Africans differed from those published in foreign literature. This knowledge is crucial for implant manufacturing companies and preoperative templating for hip surgeries. KEY WORDS: Proximal femur, Anatomy, Black population.

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The association between femoral neck shaft angle and degenerative disease of the hip in a cadaveric model

Hip International ◽

10.1177/11207000211013029 ◽

2021 ◽

pp. 112070002110130

Author(s):

Leigh-Anne Tu ◽

Douglas S Weinberg ◽

Raymond W Liu

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Hip Osteoarthritis ◽

Volume Ratio ◽

Femoral Head Coverage ◽

Neck Shaft Angle ◽

Hip Arthritis ◽

Femoral Version ◽

Shaft Angle ◽

The Impact

Background: While the influences of acetabular dysplasia and overcoverage on hip arthritis have been studied, the impact of femoral neck-shaft angle on hip arthritis is much more poorly understood. The purpose of this study is to determine if a relationship exists between neck shaft angle and the development of osteoarthritis, a better understanding of which would be useful to surgeons planning osteotomies about the hip. Methods: 533 cadaveric femora and acetabulae (1066 total) from the Hamann-Todd Osteological Collection (Cleveland, OH) were acquired. We measured true neck shaft angle using an AP photograph with the femoral neck parallel to the table. Femoral head volume to acetabular volume ratio, representing femoral head coverage, as well as femoral version were utilised. Correlation between neck shaft angle, femoral version, femoral head coverage and osteoarthritis were evaluated with multiple regression analysis. Results: The mean age and standard deviation was 56 ± 10 years. There were 64 females (12%) and 469 males. There were 380 Caucasians (71%) and 153 African-Americans. Mean femoral version was 11° ± 12° and mean true neck shaft angle was 127.7° ± 5.9° There was a strong correlation between age and arthritis (standardised beta 0.488, p < 0.001). There was a significant correlation between increasing true neck shaft angle and decreasing hip arthritis (standardised beta -0.024, p = 0.038). In the femoral head overcoverage subset, increasing true neck shaft angle was still significantly associated with decreasing hip arthritis (standardised beta −0.088, p = 0.018), although this relationship was not significant with femoral head undercoverage subset. Conclusions: With sufficient acetabular coverage, a relative increase in femoral neck shaft angle within the physiologic range is associated with decreased hip osteoarthritis. Clinical relevance: An understanding of the relationship between femoral neck shaft angle and hip osteoarthritis could be useful for surgeons planning pelvic or proximal femur osteotomies in children.

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Simultaneous Morscher’s osteotomy and arthroscopic debridement in the management of Legg–Calvé–Perthes disease: a case report and literature review

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab017 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. i4-i8

Author(s):

Batool Bosakhar ◽

Hassan Baldawi ◽

Kathy Liu ◽

Olufemi R Ayeni ◽

Waleed Kishta

Keyword(s):

Case Report ◽

Literature Review ◽

Femoral Neck ◽

Perthes Disease ◽

Labral Repair ◽

Coxa Vara ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Outcome Tool

Abstract There is a lack of consensus around optimal surgical management for Legg–Calvé–Perthes Disease (LCPD). This case report discusses the benefits of combining arthroscopic femoral neck osteochondroplasty and labral repair with Morscher’s Osteotomy (MO) for LCPD. S.A. is a 17-year-old female diagnosed with LCPD at the age of 6 years and has long-standing right hip symptoms. An arthroscopic femoral neck osteochondroplasty and labral repair followed by MO was performed. The pre-operative and 8 months post-operative International Hip Outcome Tool (iHOT-12) scores were 16.3 and 79.8 out of 100, respectively, indicating better quality-of-life. Also, the femoral neck-shaft-angle (NSA) changed from 120 pre-operative to 138.7 post-operative to represent the correction of coxa vara. The literature review revealed no published reports describing combined MO with hip arthroscopic interventions in managing LCPD. Combined arthroscopic femoral neck osteochondroplasty (with labral repair) and MO provides high patient satisfaction and improves radiographic parameters in patients with LCPD.

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Sexual Variations of Femoral Neck-Shaft Angle in the Population of Odisha

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/293 ◽

2021 ◽

Vol 10 (19) ◽

pp. 1387-1390

Author(s):

Rajeev Kumar Kanchan ◽

Sonali Subhadarsini ◽

Dharma Niranjan Mishra ◽

Chinmayi Mohapatra

Keyword(s):

Femoral Neck ◽

Ventral Surface ◽

Cross Sectional Study ◽

Cross Sectional ◽

Legal Cases ◽

Male And Female ◽

Neck Shaft Angle ◽

Femur Neck ◽

Shaft Angle ◽

The Right

BACKGROUND The peculiar waddling gait of a female attracts most of the anatomists to measure and compare the neck-shaft angle (NSA) of the femora. The femoral neck shaft angle is greater in women due to greater pelvic breadth and shorter femur. Neck-shaft angle was measured by the angle that the neck makes with the shaft of the femur and it is measured on the ventral surface of femur taking the long axis of femoral neck with the long axis of the proximal end of the femur. It gives information about the race it belongs to and normally measures 120° to 140°. The intention of this study was to establish the femoral neck shaft angle variations in adult male and female for medico-legal and anthropometric studies. METHODS This cross-sectional study was conducted on 84 adult human femora of unknown sex in the anatomy department, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, Odisha, from May 2018 to April 2019. We included all the femora which were free of damage or deformity and fully ossified indicating adult bone. Femora with any pathological changes i.e., cortical bone deterioration, extreme osteophyte activity, osteoarthritis and fracture etc. were excluded from the study. The NSA was measured by protractor and goniometer. RESULTS In the present study the NSA range for the right femur of male was 108° - 135° and for the right femur of females 117° - 135°. The left male femur was 118° - 135° and the left female femur was 120° - 135°. The mean neck shaft angle of male femora was 125.9° and the female femora was 125.7°. These measurements show that the values were more in males than the females. The value of the present study was statistically significant between male and female i.e., P < 0.0001. CONCLUSIONS These measurements are important in the medico-legal cases, reconstructive orthopaedic surgeries, hip replacement surgeries and also while constructing suitable prosthesis. This will also be helpful in the detection of sex by anatomists and forensic experts. KEY WORDS Neck Shaft Angle, Medico-Legal, Anthropometry and Goniometer

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Morphometric Study of Femoral Neck-Shaft Angle in Kolar Population and Its Clinical Importance

Indian Journal of Anatomy ◽

10.21088/ija.2320.0022.8319.16 ◽

2019 ◽

Vol 8 (3) ◽

pp. 226-232

Author(s):

Suresh NM ◽

◽

Sunitha R ◽

Aruna N ◽

Nalini JP ◽

...

Keyword(s):

Femoral Neck ◽

Clinical Importance ◽

Morphometric Study ◽

Neck Shaft Angle ◽

Shaft Angle

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The Association Between Femoral Neck-Shaft Angle and Aging and Its Influence on the Performance of Functional Activity: A Cross-Sectional Investigation

Journal of Aging and Physical Activity ◽

10.1123/japa.2019-0008 ◽

2020 ◽

Vol 28 (2) ◽

pp. 250-254

Author(s):

Ibrahim M. Altubasi

Keyword(s):

Femoral Neck ◽

Regression Models ◽

Walking Speed ◽

Functional Performance ◽

Hierarchical Regression ◽

Performance Tests ◽

Cross Sectional ◽

Neck Shaft Angle ◽

Functional Activities ◽

Shaft Angle

The purposes of this study were first to examine the association between aging and both the magnitude and asymmetry in the femoral neck-shaft angle (NSA). The second purpose was to determine the effects of both the magnitude and NSA asymmetry on the performance of functional activities in healthy individuals. Fifty-one subjects participated in this study. The femoral NSA was measured on computed tomography scout images. The participants performed four performance tests. Four hierarchical regression models were constructed to explore the effect of each predictor on the outcomes. Aging was associated with NSA asymmetry, but not with the degree of NSA. Age contributed significantly to the variability of all functional performance tests except the 10-m walking speed. The degree of the NSA did not contribute to the prediction of the functional performance tests. However, asymmetry in the NSA added significantly to the prediction of all functional performance tests except the 10-m walking speed.

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Femoral neck-shaft angle in humans: variation relating to climate, clothing, lifestyle, sex, age and side

Journal of Anatomy ◽

10.1111/joa.12073 ◽

2013 ◽

Vol 223 (2) ◽

pp. 133-151 ◽

Cited By ~ 37

Author(s):

Ian Gilligan ◽

Supichya Chandraphak ◽

Pasuk Mahakkanukrauh

Keyword(s):

Femoral Neck ◽

Neck Shaft Angle ◽

Shaft Angle

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