The femoral neck-shaft angle on plain radiographs: a systematic review

Boese, Christoph Kolja; Dargel, Jens; Oppermann, Johannes; Eysel, Peer; Scheyerer, Max Joseph; Bredow, Jan; Lechler, Philipp

doi:10.1007/s00256-015-2236-z

Cited by 97 publications

(93 citation statements)

References 48 publications

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“…The clinical validity of these features must still be assessed, particularly the centrum–collum–diaphysis angle given that it relies on patient positioning (e.g., an external rotation of the leg or marked antetorsion of the femur projects the angle incorrectly). It is also known that there is a high variance reported in the medical literature for measuring this angle, with inconsistency in how radiologists and orthopaedic surgeons account for this [25]. In addition, it is also doubtful whether coxa valga is a true, primary feature of JIA because it is more likely secondary to prolonged immobilisation from disuse secondary to non-weight-bearing [26].…”

Section: Discussionmentioning

confidence: 99%

A novel radiographic scoring system for growth abnormalities and structural change in children with juvenile idiopathic arthritis of the hip

et al. 2018

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BackgroundApproximately 20–50% of children with juvenile idiopathic arthritis (JIA) have hip involvement within 6 years of diagnosis. Scoring systems for hip-related radiographic changes are lacking.ObjectiveTo examine precision of potential radiographic variables and to suggest a scoring system.Materials and methodsWe reviewed a set of 75 pelvic radiographs from 75 children with JIA hip involvement across two European centres. We assessed findings of (1) destructive change and (2) growth abnormality, according to a pre-defined scoring system. All radiographs were scored independently by two sets of radiologists. One set scored the radiographs a second time. We used kappa statistics to rate inter- and intra-observer variability.ResultsAssessment of erosions of the femoral head, femoral neck and the acetabulum showed moderate to good agreement for the same reader (kappa of 0.5–0.8). The inter-reader agreement was, however, low (kappa of 0.1–0.3). There was moderate to high agreement for the assessment of femoral head flattening (kappa of 0.6–0.7 for the same reader, 0.3–0.7 between readers). Joint space narrowing showed moderate to high agreement both within and between observers (kappa of 0.4–0.8). Femoral neck length and width measurements, the centrum–collum–diaphysis angle, and trochanteric–femoral head lengths were relatively precise, with 95% limits of agreement within 10–15% of the observer average.ConclusionSeveral radiographic variables of destructive and growth abnormalities in children with hip JIA have reasonable reproducibility. We suggest that future studies on clinical validity focus on assessing only reproducible radiographic variables.

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Section: Discussionmentioning

confidence: 99%

A novel radiographic scoring system for growth abnormalities and structural change in children with juvenile idiopathic arthritis of the hip

et al. 2018

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“…First, the reproducibility has been questioned and various methods of measurement were described [1, 18]. While the method of Müller as presented by Boese et al seems to allow for a sufficient reliability, a current systematic analysis of its application in the published literature emphasized the necessity to improve the method of its measurement [1]. Second, the NSA shows significant differences between ethnic groups, sexes, and age [19].…”

Section: Discussionmentioning

confidence: 99%

“…Second, the NSA shows significant differences between ethnic groups, sexes, and age [19]. Of note, historical specimens showed significant differences compared to current populations [1, 19]. Third, the NSA is highly dependent from hip rotation and the projected NSA can differ significantly from the true (maximum) NSA (Figure 1) [7, 8, 15].…”

Section: Discussionmentioning

confidence: 99%

“…The femoral neck-shaft angle (NSA) is one of the most frequently applied measures of hip anatomy [1]. It is essential in the diagnosis of various pathological conditions of the hip and femur including developmental dysplasia of the hip (DDH) [2, 3], cerebral palsy (CP) in children and adults with consecutive pathologies of the hip [4], femoroacetabular impingement (FAI), Perthes disease and femoral head necrosis (FHN) [5], epiphysiolysis capitis femoris (ECF), osteogenesis imperfecta (OI), and proximal femoral fractures [6].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, the reliability of the measurement of the NSA has been challenged in recent publications and there exists no standard method of measurement in the current literature [8, 12–14]. Notably, a current systematic analysis of its application in healthy adults revealed a considerable heterogeneity in the distribution of the NSA [1]. …”

Section: Introductionmentioning

confidence: 99%

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The Modified Femoral Neck-Shaft Angle: Age- and Sex-Dependent Reference Values and Reliability Analysis

Boese

Frink

Jostmeier

et al. 2016

BioMed Research International

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Background. The femoral neck-shaft angle (NSA) is of high importance for the diagnostics and treatment of various conditions of the hip. However, rotational effects limit its precision and applicability using plain radiographs. This study introduces a novel method to measure the femoral NSA: the modified NSA (mNSA), possibly being less susceptible against rotational effects compared to the conventional NSA. Patients and Methods. The method of measurement is described and its applicability was tested in 400 pelvis computed tomography scans (800 hips). Age- and gender-dependent reference values are given and intra- and interrater reliability are analyzed. Results. The mean age of all 400 patients (800 hips) was 54.32 years (18–100, SD 22.05 years). The mean mNSA was 147.0° and the 95% confidence interval was 146.7°–147.4°. Differences of the mNSA between sexes, age groups, and sides were nonsignificant. The absolute difference between NSA and mNSA was 16.3° (range 3–31°; SD 4.4°); the correlation was high (0.738; p < 0.001). Overall, the intra- and interrater reliability were excellent for the mNSA. Interpretation. We introduced a novel concept for the analysis of the neck-shaft angle. The high reliability of the measurement has been proven and its robustness to hip rotation was demonstrated.

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Geometric Angles and Gene Expression in Cells for Structural Bone Regeneration

Wang,

Yang,

Saiding

et al. 2023

Advanced Science

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Geometry and angles play crucial roles in cellular processes; however, its mechanisms of regulation remain unclear. In this study, a series of three dimensional (3D)‐printed microfibers with different geometries is constructed using a near‐field electrostatic printing technique to investigate the regulatory mechanisms of geometry on stem cell function and bone regeneration. The scaffolds precisely mimicked cell dimensions with high porosity and interoperability. Compared with other spatial topography angles, microfibers with a 90° topology can significantly promote the expression of osteogenic gene proteins in bone marrow‐derived mesenchymal stem cells (BMSCs). The effects of different spatial structures on the expression profiles of BMSCs differentiation genes are correlated and validated using microRNA sequencing. Enrichment analysis shows that the 90° microfibers promoted osteogenesis in BMSCs by significantly upregulating miR‐222‐5p/cbfb/Runx2 expression. The ability of the geometric architecture to promote bone regeneration, as assessed using the cranial defect model, demonstrates that the 90° fiber scaffolds significantly promote new bone regeneration and neovascular neural network formation. This study is the first to elucidate the relationship between angular geometry and cellular gene expression, contributing significantly to the understanding of how geometric architecture can promote stem cell differentiation, proliferation, and function for structural bone regeneration.

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The femoral neck-shaft angle on plain radiographs: a systematic review

Abstract: Our data showed a high variance of the reported neck-shaft angles. Notably, we identified the inconsistency of the published methods of measurement as a central issue. The reported effect of rotation-correction cannot be reliably verified.

Cited by 97 publications

References 48 publications

A novel radiographic scoring system for growth abnormalities and structural change in children with juvenile idiopathic arthritis of the hip

A novel radiographic scoring system for growth abnormalities and structural change in children with juvenile idiopathic arthritis of the hip

The Modified Femoral Neck-Shaft Angle: Age- and Sex-Dependent Reference Values and Reliability Analysis

Geometric Angles and Gene Expression in Cells for Structural Bone Regeneration

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