The distance of the centre of femoral head relative to the midline of the pelvis: a prospective X-ray study of 500 adults
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20171902Keywords:
Femoral head, PelvisAbstract
Background: The mechanical axis of the femur is defined as the line joining the centre of the femoral head to the centre of the knee joint. One of the pre-requisites for a successful total knee replacement (TKR) is correct positioning of the implants, so that the mechanical axis of the limb is restored to neutral. During TKR surgery, the distal femoral anatomy can be visualized. However, to identify the mechanical axis of the femur, the location of the femoral head must be known.
Methods: We prospectively measured distance of centre of femoral head relative to the midline of the pelvis in 500 adults, using x ray of pelvic with both hip anteroposterior view done for medical causes during 2-May-2015 to 1-Jan-2017 with satisfied the following inclusion and exclusion criteria. Patient gender and age were known. Both hips were clearly shown on the radiograph and not affected by any developmental or acquired condition that might deform normal anatomy. Radiographs demonstrating unacceptable pelvic tilt or rotation were excluded. Also, we excluded any cases where degenerative changes in the native hip were more severe than grade 1, based on the Tönnis classification.
Results: There were total 500 patients in which 250 were male and 250 were female. The mean age of male was 52.14 year (SD ±80.80 mm, 95% CI 51.05 to 53.24 mm) and female was 52.11 years (SD ±8.82 mm, 95% CI 51.01 to 53.24 mm).The mean distance of femoral head centre from midline in male was 95.02mm (SD ±2.20 mm, 95% CI 94.75 to 95.30 mm) and in female was 91.54 mm (SD ±2.64 mm, 95% CI 91.22 to 91.87 mm).
Conclusions:This study provide a useful information to determine the femoral head center relative to the midline of pelvis which useful intraoperatively.
References
Kharwadkar N, Kent RE, Sharara KH, Naique S. 5 degrees to 6 degrees of distal femoralcut for uncomplicated primary total knee arthroplasty: is it safe? Knee. 2006;13:57–60.
Jiang CC, Insall JN. Effect of rotation on the axial alignment of the femur. Pitfalls in theuse of femoral intramedullary guides in total knee arthroplasty. Clin Orthop Relat Res. 1989:248:50–6.
Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am. 1977;59:77–9.
Bargren JH, Blaha JD, Freeman MA. Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res. 1983;(173):178-83.
Balakrishnan V, De SR, Lowe A. Radiographic assessment of alignment following TKA: outline of a standardized protocol and assessment of a newly devised trigonometric method of analysis. ANZ J Surg. 2010;80:344–9.
Bardakos N, Cil A, Thompson B, Stocks G. Mechanical axis cannot be restored intotal knee arthroplasty with a fixed valgus resection angle: a radiographic study. J Arthroplasty. 2007;22:85–9.
Freeman MAR, Samuelson KM. Freeman-samuelson modular total knee replacement system. 1991.
Freeman MAR. Computers in TKR. Czech Society for Orthopaedics and Traumatology Meeting; Prague. 2006.
Pinskerova V, Sosna A, Pokorny D, Freeman MAR. A computerized tensor to assisttotal knee replacement. 10thNational Congress of the Czech Society for Orthopaedics and Traumatology; Znojmo, Czech Republic; 2006.
Clark JM, Freeman MA, Witham D. The relationship of neck orientation to theshape of the proximal femur. J Arthroplasty. 1987;2:99–109.
Sugano N, Noble PC, Kamaric E. Predicting the position of the femoral head centre. J Arthroplasty. 1999;14:102–7.
Theivendran K, Hart WJ. Is the tip of the greater trochanter a reliable reference for therotation centre of the femoral head in total hip arthroplasty? Acta Orthop Belg. 2009;75:472–6.
Sawant MR, Murty A, Ireland J. A clinical method for locating the femoral headcentre during total knee arthroplasty. Knee. 2004;11:209-12.
Ritter MA, Campbell ED. A model for easy location of the centre of the femoralhead during total knee arthroplasty. J Arthroplasty. 1988;3:59–61.
Matsuda Y, Ishii Y, Ichimura K. Identifying the center of the femoral head using ultrasonography to assess the higher accuracy of femoral extramedullary guides in TKA. J Orthop Sci. 2004;9(1):6–9.
Mullaji A, Shetty GM, Kanna R, Sharma A. Variability in the range of inter-anterior superioriliac spine distance and its correlation with femoral head centre. A prospective computed tomography study of 200 adults. Skeletal Radiol. 2010;39:363–8.
Clohisy JC, Carlisle JC, Beaule PE, Kim YJ, Trousdale RT, Sierra RJ, et al. A systematicapproach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(4):47–66.
Tonnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. 1976:(119):39-47.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.
Petrie A. Statistics in orthopaedic papers. J Bone Joint Surg Br. 2006;88:1121–36.
Pouget G. Offset and neck-shaft angle in total hip arthroplasty: consequences. J Bone Joint Surg Br. 2005;90;243.
