AGE AND GENDER DIFFERENCES IN MODIFIED FEMORAL NECK-SHAFT ANGLE: AN MRI BASED OBSERVATIONAL STUDY

Najamul Huda, Ankur Agarawal, Man Mohan Sharma, Saurabh Agarwal

Abstract


Background: Femoral neck-shaft angle has its importance in describing biomechanics of hip. Measurement methods like plain radiography and
CT scans have its limitations. The modied neck-shaft angle (mNSA) drawn on MRI scans is less susceptible to rotational effects and is more
reliable for getting normal values. The present study was undertaken to assess the neck shaft angle on MRI and establish differences according to
age and gender. Methods: Total 200 adults were recruited and equally distributed under four study cohorts according to age and gender. MRI of hip
joint was analysed and mNSA was measured using pre-dened axial lines and landmarks. Results: The mean age of the participants was
49.76±18.184 years (18 to 87 years). The mean mNSA was 147.855o. Males had signicantly higher mean mNSA (149.93±6.61)o than females
(145.78±5.71)o. Though the younger age group (<60 years) had higher mNSA values (148.32±6.65) than older (> 60years) age group
(147.3900±6.35), the difference was not statistically signicant. Conclusions: We conclude that gender-based variation exists in the population
with the higher values of mNSA in males as compared to females in any age group. The age based difference is also present, but it is not signicant.
Neck shaft angle calculated on the MRI has the advantage that it is unaffected by rotation of the hip and is radiation free. The orthopaedic surgeons
can use the mNSA for the diagnosis and planning surgeries around hip, for designing implants and prosthesis. It can also be of help for the forensic
anthropologists and to the anatomists. Multicentric studies may be undertaken to include a larger population.


Full Text:

PDF

References


Zilkens C, Miese F, Jäger M, Bittersohl B, Krauspe R. Magnetic resonance imaging of hip joint cartilage and labrum. Orthop Rev (Pavia). 2011;3(2):e9.

Wright D, Whyne C, Hardisty M, Kreder HJ, Lubovsky O. Functional and Anatomic Orientation of the Femoral Head. ClinOrthopRelat Res. 2011;469(9):2583-9.

Kay RM, Jaki KA, Skaggs DL. The effect of femoral rotation on the projected femoral neck-shaft angle. J PediatrOrthop. 2000;20(6):736-9.

Gnudi S, Ripamonti C, Gualtieri G, Malavolta N. Geometry of proximal femur in the prediction of hip fracture in osteoporotic women. Br J Radiol. 1999 Aug;72(860):729-33.

Wilson JD, Eardley W, Odak S, Jennings A. To what degree is digital imaging reliable? Validation of femoral neck shaft angle measurement in the era of picture archiving and communication systems. The British Journal of Radiology. 2011;84(1000):375-9.

Anderson JY, Trinkaus E. Patterns of sexual, bilateral and interpopulational variation in human femoral neck-shaft angles. The Journal of Anatomy. 1998;192(2):279-85.

Sharma V, Kumar K, Kalia V, Soni P. Evaluation of femoral neck-shaft angle in subHimalayan population of North West India using digital radiography and dry bone measurements. Journal of the Scientific Society. 2018;45(1):3-7.

Yoshioka Y, Siu D, Cooke T. The anatomy and functional axes of the femur. J Bone Joint Surg Am. 1987;69(6):873-80.

Nelson DA, Megyesi MS. Sex and ethnic differences in bone architecture. Current osteoporosis reports. 2004;2(2):65-9.

Boese CK, Bredow J, Ettinger M, Eysel P, Thorey F, Lechler P, et al. The influence of hip rotation on femoral offset following short stem total hip arthroplasty. The Journal of Arthroplasty. 2016;31(1):312-6.

Mast NH, Impellizzeri F, Keller S, Leunig M. Reliability and agreement of measures used in radiographic evaluation of the adult hip. ClinOrthopRelat Res. 2011;469(1):188-99.

Haspl M, Bilic R. Assessment of femoral neck-shaft and antetorsion angles. International orthopaedics. 1997;20(6):363-6.

Lechler P, Frink M, Gulati A, Murray D, Renkawitz T, Bücking B, et al. The influence of hip rotation on femoral offset in plain radiographs. Acta orthopaedica. 2014;85(4):389-95.

Chung CY, Lee KM, Park MS, Lee SH, Choi IH, Cho T-J. Validity and reliability of measuring femoral anteversion and neck-shaft angle in patients with cerebral palsy. JBJS. 2010;92(5):1195-205.

Sievänen H, Karstila T, Apuli P, Kannus P. Magnetic resonance imaging of the femoral neck cortex. Acta Radiologica. 2007;48(3):308-14.

Boese CK, Frink M, Jostmeier J, Haneder S, Dargel J, Eysel P, et al. The modified femoral neck-shaft angle: age-and sex-dependent reference values and reliability analysis. Biomed Res Int. 2016; 2016: 8645027.

Pathak SK, Maheshwari P, Ughareja P, Gadi D, Gour S. Evaluation of femoral neck shaft angle on plain radiographs and its clinical implications. Int J Res Orthop. 2016;2(4):383-6.

Siwach R, Dahiya S. Anthropometric study of proximal femur geometry and its clinical application. Indian J Orthop. 2003;37(4):247.

Engh CA. Hip arthroplasty with a Moore prosthesis with porous coating. A five-year study. ClinOrthopRelat Res. 1983(176):52-66.

Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS. The anatomic basis of femoral component design. ClinOrthopRelat Res. 1988(235):148-65.

Byrne DP, Mulhall KJ, Baker JF. Anatomy & Biomechanics of the Hip. Open Sports Medicine Journal. 2010;4:51-7.

Chauhan R, Paul S, Dhaon B. Anatomical parameters of North Indian hip joints: cadaveric study. J AnatSoc India. 2002;51(1):39-42.

Greenwald A, O'Connor J. The transmission of load through the human hip joint. Journal of Biomechanics. 1971;4(6):507-28.

Daniel M, IgliC A, Kralj‐IgliC V. The shape of acetabular cartilage optimizes hip contact stress distribution. Journal of anatomy. 2005;207(1):85-91.

Dvorak M, Duncan C, Day B. Arthroscopic anatomy of the hip. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 1990;6(4):264-73.

Pujari R, Ravi SG, Naveen N, Roopa C. Evaluation of neck shaft angle of femur on dry bones. J of Evolufion of Med and Dent Sci. 2015;4(32):5518-22.

Herring J.A. Congenital CoxaVara. In : Herring J, editors. Tachdjian’sPediatric Orthopaedics (Fifth edition.). Philadelphia: Saunders/Elsevier’s, 2014. p. 666-677

Anderson LC, Blake DJ. The anatomy and biomechanics of the hip joint. J Back MusculoskeletRehabil. 1994;4(3):145-53.

Cibulka MT. Determination and significance of femoral neck anteversion. Physical Therapy. 2004;84(6):550-8.

Gulan G, Matovinović D, Nemec B, Rubinić D, Ravlić-Gulan J. Femoral neck anteversion: values, development, measurement, common problems. Coll Antropol. 2000;24(2):521-7.

Harkess J, Crockarell J. Arthroplasty of the hip. In: Azar F, Beaty J, Canale S, editors. Campbell’s Operative Orthopaedics. 13th ed. International edition: Elsevier; 2017. p. 167-168.

Radin EL. Biomechanics of the human hip. ClinOrthopRelat Res.1980 (152):28-34.

Maquet P.G.J. Biomechanics of the Hip. In: Maquet P.G.J., editors. Biomechanics of the Hip. Berlin, Heidelberg, New York: Springer- Verlag; 1985.p.1-45.

Parsons FG. The Characters of the English Thigh-Bone. J Anat Physiol. 1914; 48(Pt 3):238-67.

Hoaglund FT, Low WD. Anatomy of the femoral neck and head, with comparative data from Caucasians and Hong Kong Chinese. ClinOrthopRelat Res.1980;152:10-6.

Reikeras O, Høiseth A, Regstad A, Fönstelien E. Femoral neck angles: a specimen study with special regard to bilateral differences. Acta Orthopaedica Scandinavica. 1982;53(5):775-9.

Rubin P, Leyvraz P, Aubaniac J, Argenson J, Esteve P, De Roguin B. The morphology of the proximal femur. A three-dimensional radiographic analysis. J Bone Joint Surg Br. 1992;74(1):28-32.

Isaac B, Vettivel S, Prasad R, Jeyaseelan L, Chandi G. Prediction of the femoral neck‐shaft angle from the length of the femoral neck. Clin Anat.1997; 10(5):318-23.

Da Silva VJ, Oda JY, Santana DMG. Anatomical aspects of the proximal femur of adult Brazilians. Int. J. Morphol. 2003; 21(4):303-8.

Nissen N, Hauge EM, Abrahamsen B, Jensen J-EB, Mosekilde L, Brixen K. Geometry of the proximal femur in relation to age and sex: a cross-sectional study in healthy adult Danes. Acta Radiologica. 2005;46(5):514-8.

Toogood PA, Skalak A, Cooperman DR. Proximal femoral anatomy in the normal human population. ClinOrthopRelat Res. 2009;467(4):876-85.

Gilligan I, Chandraphak S, Mahakkanukrauh P. Femoral neck‐shaft angle in humans: variation relating to climate, clothing, lifestyle, sex, age and side. Journal of anatomy. 2013;223(2):133-51.

Khan SM, Saheb SH. Study on neck shaft angle and femoral length of south Indian femurs. Int J Anat Res. 2014;2(4):633-35.

Boese CK, Dargel J, Oppermann J, Eysel P, Scheyerer MJ, Bredow J, et al. The femoral neck-shaft angle on plain radiographs: a systematic review. Skeletal Radiology. 2016;45(1):19-28.

Shrestha R, Gupta H, Hamal R, Pandit R. Radiographic Anatomy of the Neck-Shaft Angle of Femur in Nepalese People: Correlation with its Clinical Implication. Kathmandu Univ Med J (KUMJ). 2018;16(62):124-8.

Husmann O, Rubin PJ, Leyvraz P-F, de Roguin B, Argenson J-N. Three-dimensional morphology of the proximal femur. J Arthroplasty. 1997;12(4):444-50.

Rawal B, Ribeiro R, Malhotra R, Bhatnagar N. Anthropometric measurements to design best-fit femoral stem for the Indian population. Indian J Orthop. 2012;46(1):46-53.

Roy S, Kundu R, Medda S, Gupta A, Nanrah BK. Evaluation of proximal femoral geometry in plain anterior-posterior radiograph in eastern-Indian population. Journal of clinical and diagnostic research: J ClinDiagn Res. 2014;8(9):AC01–AC03.

Saikia K, Bhuyan S, Rongphar R. Anthropometric study of the hip joint in Northeastern region population with computed tomography scan.Indian J Orthop. 2008;42(3):260-6.

Unnanuntana A, Toogood P, Hart D, Cooperman D, Grant RE. Evaluation of proximal femoral geometry using digital photographs. J Orthop Res. 2010;28(11):1399-404.

Lavelle CL. An analysis of the human femur. Am J Anat. 1974;141(3):415-26.

Graham TM, Yarbrough JD. Anthropometric studies of the long bones of the “Shell Mound” Indians. Am J PhysAnthropol. 1968;28(1):85-91.

Purkait R. Standardizing the technique of measurement of the collo-diaphyseal angle. Med Sci Law. 1996;36(4):290-4.


Refbacks

  • There are currently no refbacks.