Femoral antecurvation—A 3D CT Analysis of 1232 adult femurs

Thiesen, Darius M; Prange, Felix; Berger-Groch, Josephine; Ntalos, Dimitris; Petersik, Andreas; Hofstätter, Bernhard; Rueger, Johannes M.; Hartel, Maximilian

doi:10.1371/journal.pone.0204961

Cited by 27 publications

(34 citation statements)

References 26 publications

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“…1 and 2). As shown in prior studies, this method provides accurate and consistent results 13,14 . The operators who defined the bony landmarks were an experienced trauma, hip and pelvic surgeon (MH) and a trauma surgery resident (DT) with focus on pelvic trauma along with a Stryker employee (BH).…”

supporting

confidence: 64%

The three-dimensional bone mass distribution of the posterior pelvic ring and its key role in transsacral screw placement

Thiesen

Ntalos

Berger-Groch

et al. 2020

Sci Rep

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information compared to the traditional greyscale CT-slides. We hypothesized that there would be a constant lower bone density in the posterior pelvic ring screw corridors in individuals with decreased bone stock in the 5th lumbar vertebra. Methods Study population. Five hundred and thirty-seven (n = 537) raw CT datasets were analyzed. These had all originally been obtained for medical reasons: 20% patients after trauma, 70% for CT angiography and 10% for non-defined indications (median pixel spacing: 0.78 mm, median slice spacing: 1.00 mm). The data was collected retrospectively by Stryker Trauma GmbH between 2008 and 2017 with the prior written consent of the patient. Personal data such as name, date of birth or date of CT associated with the datasets were removed and not provided to the company. CT scans that included the skull were also excluded. The available demographic data generally included age, BMI and gender. In some cases, BMI, age or gender were not provided due to individual hospital data protection policies. Fractured or severely malformed pelvises (tumorous, post-osteomyelitis, post-traumatic) and pelvises with implants were excluded in advance. With these preconditions, the inclusion criteria were a fully scanned pelvis, without radiological artifacts, and the patient informed consent. The following inclusion criteria were applied to the initial study cohort: the fifth lumbar vertebra had to be included in the CT scan and the vertebral body had to be clearly defined and exhibit no degenerative changes in L5, or a sacralization or lumbalization of vertebral bodies; the S1 and S2 screw corridors (as defined below) did not interfere with the cortical boundary. This resulted in a final study cohort of 324 datasets. The mean age and standard deviation of the study population was 60.4 ± 17.6 years (17 to 93 years); 49 datasets were for patients of unknown age. There were 107 female (33%) and 217 male (67%) patients.

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supporting

confidence: 64%

The three-dimensional bone mass distribution of the posterior pelvic ring and its key role in transsacral screw placement

Thiesen

Ntalos

Berger-Groch

et al. 2020

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“…In order to ensure better proximal pressure distribution, the larger femoral prosthesis stem would be chosen, and the femoral stem length would be increased, thereby increasing the point between the cortex and the impact of risk within the plants. [26][27][28] In addition, the existing biological femoral stem prosthesis is mainly designed based on patients in European or American, and therefore the LK. LCU femoral stem prosthesis of the same length used in this study was bound to increase the risk of collision when implanted into the body of Asians.…”

Section: Discussionmentioning

confidence: 99%

Impact of Femoral Stem Prosthesis Tip On Femoral Cortex After Primary Total Hip Arthroplasty (THA)

Zhang

Wang

Cheng

et al. 2021

Preprint

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Background: The mechanisms of pain after total hip arthroplasty (THA) is not clear, which may be related to its impact on the femoral cortex caused by improper prosthesis placement. This study was to explore the the impact of the femoral stem prosthesis on the femoral cortex after implantation, and its relationship with postoperative thigh pain. Methods: Totally 172 patients who underwent primary THA were retrospectively analyzed, who were divided into the impact (n=25) and non-impact (n=147) groups. Contact or penetration of the femoral stem prosthesis tip with the distal femoral cortex was defined as impingement. Patients were followed up and recorded.Results: In the patients undergoing primary THA, 25 patients (14.5%) had impact, including 7 males and 18 females. Most of the patients in the impact group were women of small stature. In the impact group, the postoperative thigh pain was more obvious, and the Harris Hip score (HHS) was lower, compared with the non-impact group (P < 0.05). The regression analysis showed that height (OR=1.196; 95%CI: 1.059-1.351; P=0.004) and prosthesis implant angle (PIA) (OR=0.208; 95%CI: 0.074-0.584; P=0.003) were important risk factors for distal femoral cortical impingement in patients who underwent THA. Conclusions: Patients with short stature should have adequate preoperative planning for primary THA, to prevent increased risk of postoperative thigh pain due to impinging femoral stem implants.

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“…However, in a comparison of different ethnic groups in America, Asian populations showed an increased risk of AFF relative to other races 9 – 12 . Asian women have a more curved femur than Caucasians, while Africans tend to have the straightest femurs 13 – 15 , which would explain the high prevalence of AFF in Asians. It has also been reported that diaphyseal AFF is more common than subtrochanter AFF in Korean patients with AFF 6 , 16 .…”

Section: Introductionmentioning

confidence: 99%

Differences in femur geometry and bone markers in atypical femur fractures and the general population

Kim

2021

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This study aimed to identify differences in femur geometry between patients with subtrochanteric/shaft atypical femur fractures (AFFs) and the general population, and to evaluate the biomechanical factors related to femoral bowing in AFFs. We retrospectively reviewed 46 patients. Data on age, and history and duration of bisphosphonate use were evaluated. Femur computed tomography images were reconstructed into a 3D model, which was analyzed with a geometry analysis program to obtain the femur length, femur width and length, and femoral bowing. Patients were divided into two groups according to fracture location: the subtrochanteric and shaft AFF groups. We compared all parameters between groups, and also between each group and a general population of 300 women ≥ 60 years. Thirty-five patients had a history of bisphosphonate use (average duration, 6.1 years; range, 0.8–20 years). There was no statistical difference in bone turnover markers between the two groups. The shaft AFF group had a lower radius of curvature (ROC) (P = 0.001), lower bone mineral density (BMD, T score) (P = 0.020), and lower calcium (P = 0.016). However, other parameters and rate of bisphosphonate use were not significantly different. There were no significant differences in the parameters of the subtrochanter AFF group and the general population, but the shaft AFF group demonstrated a wider femur width (P < 0.001), longer anteroposterior length (P = 0.001), and lower ROC (P < 0.001) than the general population. Femoral bowing and width increased in shaft AFFs, but similar to subtrochanter AFFs compared to the general population. Our results highlight the biomechanical factors of femur geometry in AFFs.

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Femoral antecurvation—A 3D CT Analysis of 1232 adult femurs

Cited by 27 publications

References 26 publications

The three-dimensional bone mass distribution of the posterior pelvic ring and its key role in transsacral screw placement

The three-dimensional bone mass distribution of the posterior pelvic ring and its key role in transsacral screw placement

Impact of Femoral Stem Prosthesis Tip On Femoral Cortex After Primary Total Hip Arthroplasty (THA)

Differences in femur geometry and bone markers in atypical femur fractures and the general population

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