Femoral head diameters in Nepalese patients undergoing hemiarthroplasty

<p class="abstract"><strong>Background:</strong> Sizing of the femoral head is important for determining the appropriate size of implants to be used for a patient undergoing hip arthroplasty. The present study aimed to determine the mean diameter of femoral head in Nepalese population who underwent hemiarthroplasty in our department.</p><p class="abstract"><strong>Methods:</strong> We retrospectively reviewed the medical records of patients who underwent hemiarthroplasty from December 2016 till December 2020. We included patients aged more than 50 years who underwent hemiarthroplasty. The diameter of the femoral head was measured intraoperatively using standard fully circular templates. For radiological measurements, X-ray of pelvis with hips anteroposterior view were included.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 600 femoral heads were evaluated, 400 of women and 200 of men. Of these cases, the femoral head diameter were evaluated based on x-ray pelvis in 500 cases and rest of the 100 cases were evaluated intraoperatively. The mean age of the patients in our sample was 75.2±9.4 (range 50–90) years. Overall, the mean femoral head diameter (with intact articular cartilage) was 44.9±3.2 (range 39–53 mm) mm. Among the male patients, mean femoral head diameter was 47.7±2.8 mm, which was found to be significantly higher than that of female patients, who had a mean femoral head diameter of 43.7±2.4 mm, p value &lt;0.05.</p><p class="abstract"><strong>Conclusions:</strong> Further studies are needed in other geographical locations, so that reference values could be established for specific regions.</p>

Does Proximal Hip Geometry Affect Fracture Type in The Elderly Population?

Background The aim of this study was to determine the differences in proximal femoral geometric (PFG) parameters between patients with femoral neck fractures(FNFs) and patients with intertrochanteric fractures (ITFs). Methods We retrospectively evaluated 114 patients (33 FNFs, 81 ITFs.) who were hospitalized secondary to hip fractures. Patients were divided into two groups: patients with FNFs and patients with ITFs. The PFG parameters (the neck shaft angle, center-edge angle, femoral head diameter, femoral neck diameter, neck/head ratio, femoral neck axial length, femoral shaft diameter, hip axial length, and neck/hip length ratio) were measured on the hip joint radiographs. Results There were no statistically significant differences in age and gender between the FNF and ITF groups. In addition, there were no statistically significant differences in the PFG parameters between the FNF and ITF groups except in the neck/hip length ratio (NHLR) (0.86 ± 0.03 vs 0.84 ± 0.03, p = 0.05). When a 3-way multivariate analysis was performed according to gender, fracture type, and fracture site, the femoral head diameter, femoral neck diameter, femoral neck axial length, femoral shaft diameter, hip axial length, and NHLR were found to be greater in females than in males, and a statistically significant relationship was found between gender and these variables. Conclusion Only the NHLR was significantly higher in the ITF group, so this study revealed that a higher NHLR, which is the presence of a longer hip axis combined with a shorter neck axis, is a risk factor for ITF after a minor trauma.

Radiographic analysis of the proximal femoral anatomy in the Croatian population

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.

Capsular closure outweighs head size in preventing dislocation following revision total hip arthroplasty

Introduction:The high dislocation rate following revision total hip arthroplasty (THA) has been shown to be significantly reduced by closing the posterior capsule and by the use of large diameter femoral heads. The relative importance of each of these strategies on the rate of dislocation remains unknown. We undertook a study to determine if increasing femoral head diameter, in addition to posterior capsular closure would influence the dislocation rate following revision THA.Methods:We retrospectively reviewed 144 patients who underwent a revision THA. We included all patients who underwent revision THA with closure of the posterior capsule and who had at least a 2-year minimum follow-up. 48 patients had a 28-mm femoral head, 47 had a 32-mm head and 49 patients had a 36-mm femoral head.Results:At a minimum follow-up of 2 years, there were 3 dislocations. There were no dislocations in the 28-mm group (0%), 2 in the 32-mm group (4%) and 1 in the 36-mm group (2%). Head size alone was not found to significantly decrease the risk of dislocation (28-mm versus 32-mm p = 0.12; 28-mm versus 36-mm p = 0.27; 32-mm versus 36-mm p = 0.40).Conclusion:Both large diameter heads and careful attention to surgical technique with posterior capsular closure can decrease the historically high dislocation rate after revision THA when utilising the posterolateral approach. Capsular closure outweighs the effect of femoral head diameter in preventing dislocation following revision THA through a posterolateral approach.