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Erschienen in: Clinical Orthopaedics and Related Research® 5/2013

01.05.2013 | Basic Research

Are the Left and Right Proximal Femurs Symmetric?

verfasst von: Ernest Y. Young, MS, Jeremy Gebhart, BS, Daniel Cooperman, MD, Nicholas U. Ahn, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 5/2013

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Abstract

Background

The contralateral femur frequently is used for preoperative templating for THA or hemiarthroplasty when the proximal femur is deformed by degenerative changes or fracture. Although femoral symmetry is assumed in these situations, it is unclear to what degree the contralateral femur is symmetrical.

Questions/purpose

We therefore defined the degree of asymmetry between left and right proximal femurs and determined whether it was affected by demographics and proximal femoral anatomy.

Methods

We obtained 160 paired femurs from individuals (20–40 years old), evenly distributed for gender and ethnicity (African-American and Caucasian). The height and weight of the individuals were recorded. We measured the femoral head diameter, minimal femoral neck diameter in the AP and cephalocaudal (CC) planes, and the AP femoral diaphyseal diameter. The absolute and percent differences were determined.

Results

All femoral measurements showed an absolute difference less than 2 mm and a percent asymmetry and difference less than 2% for the femoral head, less than 4% for the femoral neck, and less than 3.5% for the femoral shaft. We found no correlation or predictive value between absolute differences and asymmetry and age, ethnicity, gender, or weight. Height was negatively associated with femoral head differences and thus increased symmetry of the femoral head.

Conclusions

Our data support assumptions of substantial symmetry of the proximal femur and highlights that asymmetry is not affected by demographics or the size of the proximal femur. Asymmetry tends not to occur in isolated segments of the femur.
Literatur
1.
Zurück zum Zitat Arie E, Johnson F, Harrison MH, Hughes JR, Small P. Femoral head shape in Perthes’ disease: is the contralateral hip abnormal? Clin Orthop Relat Res. 1986;209:77–88.PubMed Arie E, Johnson F, Harrison MH, Hughes JR, Small P. Femoral head shape in Perthes’ disease: is the contralateral hip abnormal? Clin Orthop Relat Res. 1986;209:77–88.PubMed
2.
Zurück zum Zitat Asala SA. Sex determination from the head of the femur of South African whites and blacks. Forensic Sci Int. 2001;117:15–22.PubMedCrossRef Asala SA. Sex determination from the head of the femur of South African whites and blacks. Forensic Sci Int. 2001;117:15–22.PubMedCrossRef
3.
Zurück zum Zitat Auerbach BM, Ruff CB. Limb bone bilateral asymmetry: variability and commonality among modern humans. J Hum Evol. 2006;50:203–218.PubMedCrossRef Auerbach BM, Ruff CB. Limb bone bilateral asymmetry: variability and commonality among modern humans. J Hum Evol. 2006;50:203–218.PubMedCrossRef
4.
Zurück zum Zitat Barrack RL, Burnett SJ. Preoperative planning for revision total hip arthroplasty. J Bone Joint Surg Am. 2005;87:2800–2811.PubMed Barrack RL, Burnett SJ. Preoperative planning for revision total hip arthroplasty. J Bone Joint Surg Am. 2005;87:2800–2811.PubMed
5.
Zurück zum Zitat Berry DJ, Harmsen WS, Cabanela ME, Morrey BF. Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements: factors affecting survivorship of acetabular and femoral components. J Bone Joint Surg Am. 2002;84:171–177.PubMed Berry DJ, Harmsen WS, Cabanela ME, Morrey BF. Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements: factors affecting survivorship of acetabular and femoral components. J Bone Joint Surg Am. 2002;84:171–177.PubMed
6.
Zurück zum Zitat Casper DS, Kim GK, Parvizi J, Freeman TA. Morphology of the proximal femur differs widely with age and sex: relevance to design and selection of femoral prostheses. J Orthop Res. 2012;30:1162–1166.PubMedCrossRef Casper DS, Kim GK, Parvizi J, Freeman TA. Morphology of the proximal femur differs widely with age and sex: relevance to design and selection of femoral prostheses. J Orthop Res. 2012;30:1162–1166.PubMedCrossRef
8.
Zurück zum Zitat Dargel J, Feiser J, Gotter M, Pennig D, Koebke J. Side differences in the anatomy of human knee joints. Knee Surg Sports Traumatol Arthrosc. 2009;17:1368–1376.PubMedCrossRef Dargel J, Feiser J, Gotter M, Pennig D, Koebke J. Side differences in the anatomy of human knee joints. Knee Surg Sports Traumatol Arthrosc. 2009;17:1368–1376.PubMedCrossRef
9.
Zurück zum Zitat Della Valle AG, Padgett DE, Salvati EA. Preoperative planning for primary total hip arthroplasty. J Am Acad Orthop Surg. 2005;13:455–462.PubMed Della Valle AG, Padgett DE, Salvati EA. Preoperative planning for primary total hip arthroplasty. J Am Acad Orthop Surg. 2005;13:455–462.PubMed
10.
Zurück zum Zitat Dore DD, Rubash HE. Primary total hip arthroplasty in the older patient: optimizing the results. Instr Course Lect. 1994;43:347–357.PubMed Dore DD, Rubash HE. Primary total hip arthroplasty in the older patient: optimizing the results. Instr Course Lect. 1994;43:347–357.PubMed
11.
Zurück zum Zitat Eggli S, Pisan M, Müller ME. The value of preoperative planning for total hip arthroplasty. J Bone Joint Surg Br. 1998;80:382–390.PubMedCrossRef Eggli S, Pisan M, Müller ME. The value of preoperative planning for total hip arthroplasty. J Bone Joint Surg Br. 1998;80:382–390.PubMedCrossRef
12.
Zurück zum Zitat Ellis AR, Noble PC, Schroder SJ, Thompson MT, Stocks GW. The cam impinging femur has multiple morphologic abnormalities. J Arthroplasty. 2011;26(6 suppl):59–65.PubMedCrossRef Ellis AR, Noble PC, Schroder SJ, Thompson MT, Stocks GW. The cam impinging femur has multiple morphologic abnormalities. J Arthroplasty. 2011;26(6 suppl):59–65.PubMedCrossRef
13.
Zurück zum Zitat Ferguson AB, Howorth MB. Coxa magna: a condition related to coxa plana. JAMA. 1935;104:808–812.CrossRef Ferguson AB, Howorth MB. Coxa magna: a condition related to coxa plana. JAMA. 1935;104:808–812.CrossRef
14.
Zurück zum Zitat Fernandez De Valderama JA. The “observation hip” syndrome and its late sequelae. J Bone Joint Surg Br. 1963;45:462–470. Fernandez De Valderama JA. The “observation hip” syndrome and its late sequelae. J Bone Joint Surg Br. 1963;45:462–470.
15.
Zurück zum Zitat Fessy MH, Seutin B, Béjui J. Anatomical basis for the choice of the femoral implant in the total hip arthroplasty. Surg Radiol Anat. 1997;19:283–286.PubMedCrossRef Fessy MH, Seutin B, Béjui J. Anatomical basis for the choice of the femoral implant in the total hip arthroplasty. Surg Radiol Anat. 1997;19:283–286.PubMedCrossRef
16.
Zurück zum Zitat Gonzalez Della Valle A, Comba F, Taveras N, Salvati EA. The utility and precision of analogue and digital preoperative planning for total hip arthroplasty. Int Orthop. 2008;32:289–294.PubMedCrossRef Gonzalez Della Valle A, Comba F, Taveras N, Salvati EA. The utility and precision of analogue and digital preoperative planning for total hip arthroplasty. Int Orthop. 2008;32:289–294.PubMedCrossRef
17.
Zurück zum Zitat Gonzalez Della Valle A, Slullitel G, Piccaluga F, Salvati EA. The precision and usefulness of preoperative planning for cemented and hybrid primary total hip arthroplasty. J Arthroplasty. 2005;20:51–58.PubMedCrossRef Gonzalez Della Valle A, Slullitel G, Piccaluga F, Salvati EA. The precision and usefulness of preoperative planning for cemented and hybrid primary total hip arthroplasty. J Arthroplasty. 2005;20:51–58.PubMedCrossRef
18.
Zurück zum Zitat Hoaglund FT, Low WD. Anatomy of the femoral neck and head, with comparative data from Caucasians and Hong Kong Chinese. Clin Orthop Relat Res. 1980;152:10–16.PubMed Hoaglund FT, Low WD. Anatomy of the femoral neck and head, with comparative data from Caucasians and Hong Kong Chinese. Clin Orthop Relat Res. 1980;152:10–16.PubMed
19.
Zurück zum Zitat Hofmann AA, Skrzynski MC. Leg-length inequality and nerve palsy in total hip arthroplasty: a lawyer awaits! Orthopedics. 2000;23:943–944.PubMed Hofmann AA, Skrzynski MC. Leg-length inequality and nerve palsy in total hip arthroplasty: a lawyer awaits! Orthopedics. 2000;23:943–944.PubMed
20.
Zurück zum Zitat Johnson AJ, Costa CR, Mont MA. Do we need gender-specific total joint arthroplasty? Clin Orthop Relat Res. 2011;469:1852–1858.PubMedCrossRef Johnson AJ, Costa CR, Mont MA. Do we need gender-specific total joint arthroplasty? Clin Orthop Relat Res. 2011;469:1852–1858.PubMedCrossRef
21.
Zurück zum Zitat Kallio PE. Coxa magna following transient synovitis of the hip. Clin Orthop Relat Res. 1988;228:49–56.PubMed Kallio PE. Coxa magna following transient synovitis of the hip. Clin Orthop Relat Res. 1988;228:49–56.PubMed
22.
Zurück zum Zitat Liu RW, Toogood P, Hart DE, Davy DT, Cooperman DR. The effect of varus and valgus osteotomies on femoral version. J Pediatr Orthop. 2009;29:666–675.PubMedCrossRef Liu RW, Toogood P, Hart DE, Davy DT, Cooperman DR. The effect of varus and valgus osteotomies on femoral version. J Pediatr Orthop. 2009;29:666–675.PubMedCrossRef
23.
Zurück zum Zitat Maloney WJ, Keeney JA. Leg length discrepancy after total hip arthroplasty. J Arthroplasty. 2004;19(4 suppl 1):108–110.PubMedCrossRef Maloney WJ, Keeney JA. Leg length discrepancy after total hip arthroplasty. J Arthroplasty. 2004;19(4 suppl 1):108–110.PubMedCrossRef
24.
Zurück zum Zitat McAndrew MP, Weinstein SL. A long-term follow-up of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1984;66:860–869.PubMed McAndrew MP, Weinstein SL. A long-term follow-up of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1984;66:860–869.PubMed
25.
Zurück zum Zitat Meermans G, Malik A, Witt J, Haddad F. Preoperative radiographic assessment of limb-length discrepancy in total hip arthroplasty. Clin Orthop Relat Res. 2011;469:1677–1682.PubMedCrossRef Meermans G, Malik A, Witt J, Haddad F. Preoperative radiographic assessment of limb-length discrepancy in total hip arthroplasty. Clin Orthop Relat Res. 2011;469:1677–1682.PubMedCrossRef
26.
Zurück zum Zitat Murshed KA, Cicekcibasi AE, Karabacakoglu A, Seker M, Ziylan T. Distal femur morphometry: a gender and bilateral comparative study using magnetic resonance imaging. Surg Radiol Anat. 2005;27:108–112.PubMedCrossRef Murshed KA, Cicekcibasi AE, Karabacakoglu A, Seker M, Ziylan T. Distal femur morphometry: a gender and bilateral comparative study using magnetic resonance imaging. Surg Radiol Anat. 2005;27:108–112.PubMedCrossRef
27.
Zurück zum Zitat Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS. The anatomic basis of femoral component design. Clin Orthop Relat Res. 1988;235:148–165.PubMed Noble PC, Alexander JW, Lindahl LJ, Yew DT, Granberry WM, Tullos HS. The anatomic basis of femoral component design. Clin Orthop Relat Res. 1988;235:148–165.PubMed
28.
Zurück zum Zitat Pierre MA, Zurakowski D, Nazarian A, Hauser-Kara DA, Snyder BD. Assessment of the bilateral asymmetry of human femurs based on physical, densitometric, and structural rigidity characteristics. J Biomech. 2010;43:2228–2236.PubMedCrossRef Pierre MA, Zurakowski D, Nazarian A, Hauser-Kara DA, Snyder BD. Assessment of the bilateral asymmetry of human femurs based on physical, densitometric, and structural rigidity characteristics. J Biomech. 2010;43:2228–2236.PubMedCrossRef
29.
Zurück zum Zitat Purkait R. Sex determination from femoral head measurements: a new approach. Leg Med (Tokyo). 2003;5(suppl 1):S347–350.CrossRef Purkait R. Sex determination from femoral head measurements: a new approach. Leg Med (Tokyo). 2003;5(suppl 1):S347–350.CrossRef
30.
Zurück zum Zitat Ranawat CS. The pants too short, the leg too long! Orthopedics. 1999;22:845–846.PubMed Ranawat CS. The pants too short, the leg too long! Orthopedics. 1999;22:845–846.PubMed
31.
Zurück zum Zitat Rawal B, Ribeiro R, Malhotra R, Bhatnagar N. Anthropometric measurements to design best-fit femoral stem for the Indian population. Indian J Orthop. 2012;46:46–53.PubMedCrossRef Rawal B, Ribeiro R, Malhotra R, Bhatnagar N. Anthropometric measurements to design best-fit femoral stem for the Indian population. Indian J Orthop. 2012;46:46–53.PubMedCrossRef
32.
Zurück zum Zitat Rosenbaum TG, Hamblin T, Bloebaum RD. Determining the degree of cortical bone asymmetry in bilateral, nonpathological, human femur pairs. J Biomed Mater Res A. 2006;76:450–455.PubMed Rosenbaum TG, Hamblin T, Bloebaum RD. Determining the degree of cortical bone asymmetry in bilateral, nonpathological, human femur pairs. J Biomed Mater Res A. 2006;76:450–455.PubMed
33.
Zurück zum Zitat Rubin PJ, Leyvraz PF, Aubaniac JM, Argenson JN, Estève P, de Roguin B. The morphology of the proximal femur: a three-dimensional radiographic analysis. J Bone Joint Surg Br. 1992;74:28–32.PubMed Rubin PJ, Leyvraz PF, Aubaniac JM, Argenson JN, Estève P, de Roguin B. The morphology of the proximal femur: a three-dimensional radiographic analysis. J Bone Joint Surg Br. 1992;74:28–32.PubMed
34.
Zurück zum Zitat Scheerlinck T. Primary hip arthroplasty templating on standard radiographs: a stepwise approach. Acta Orthop Belg. 2010;76:432–442.PubMed Scheerlinck T. Primary hip arthroplasty templating on standard radiographs: a stepwise approach. Acta Orthop Belg. 2010;76:432–442.PubMed
35.
Zurück zum Zitat Sproul RC, Reynolds HM, Lotz JC, Ries MD. Relationship between femoral head size and distance to lesser trochanter. Clin Orthop Relat Res. 2007;461:122–124.PubMed Sproul RC, Reynolds HM, Lotz JC, Ries MD. Relationship between femoral head size and distance to lesser trochanter. Clin Orthop Relat Res. 2007;461:122–124.PubMed
36.
Zurück zum Zitat Strecker W, Keppler P, Gebhard F, Kinzl L. Length and torsion of the lower limb. J Bone Joint Surg Br. 1997;79:1019–1023.PubMedCrossRef Strecker W, Keppler P, Gebhard F, Kinzl L. Length and torsion of the lower limb. J Bone Joint Surg Br. 1997;79:1019–1023.PubMedCrossRef
37.
Zurück zum Zitat Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1981;63:1095–1108.PubMed Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1981;63:1095–1108.PubMed
38.
Zurück zum Zitat Sugano N, Noble PC, Kamaric E. Predicting the position of the femoral head center. J Arthroplasty. 1999;14:102–107.PubMedCrossRef Sugano N, Noble PC, Kamaric E. Predicting the position of the femoral head center. J Arthroplasty. 1999;14:102–107.PubMedCrossRef
39.
Zurück zum Zitat Suh KT, Moon KP, Lee HS, Lee CK, Lee JS. Consideration of the femoral head cartilage thickness in preoperative planning in bipolar hemiarthroplasty. Arch Orthop Trauma Surg. 2009;129:1309–1315.PubMedCrossRef Suh KT, Moon KP, Lee HS, Lee CK, Lee JS. Consideration of the femoral head cartilage thickness in preoperative planning in bipolar hemiarthroplasty. Arch Orthop Trauma Surg. 2009;129:1309–1315.PubMedCrossRef
40.
Zurück zum Zitat Teitz CC, Lind BK, Sacks BM. Symmetry of the femoral notch width index. Am J Sports Med. 1997;25:687–690.PubMedCrossRef Teitz CC, Lind BK, Sacks BM. Symmetry of the femoral notch width index. Am J Sports Med. 1997;25:687–690.PubMedCrossRef
41.
Zurück zum Zitat Tonnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81:1747–1770.PubMed Tonnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81:1747–1770.PubMed
42.
Zurück zum Zitat Toogood PA, Skalak A, Cooperman DR. Proximal femoral anatomy in the normal human population. Clin Orthop Relat Res. 2009;467:876–885.PubMedCrossRef Toogood PA, Skalak A, Cooperman DR. Proximal femoral anatomy in the normal human population. Clin Orthop Relat Res. 2009;467:876–885.PubMedCrossRef
43.
Zurück zum Zitat Umer M, Sepah YJ, Khan A, Wazir A, Ahmed M, Jawad MU. Morphology of the proximal femur in a Pakistani population. J Orthop Surg (Hong Kong). 2010;18:279–281. Umer M, Sepah YJ, Khan A, Wazir A, Ahmed M, Jawad MU. Morphology of the proximal femur in a Pakistani population. J Orthop Surg (Hong Kong). 2010;18:279–281.
44.
Zurück zum Zitat Unnanuntana A, Toogood P, Hart D, Cooperman D, Grant RE. Evaluation of proximal femoral geometry using digital photographs. J Orthop Res. 2010;28:1399–1404.PubMedCrossRef Unnanuntana A, Toogood P, Hart D, Cooperman D, Grant RE. Evaluation of proximal femoral geometry using digital photographs. J Orthop Res. 2010;28:1399–1404.PubMedCrossRef
45.
Zurück zum Zitat Unnanuntana A, Toogood P, Hart D, Cooperman D, Grant RE. The evaluation of two references for restoring proximal femoral anatomy during total hip arthroplasty. Clin Anat. 2010;23:312–318.PubMed Unnanuntana A, Toogood P, Hart D, Cooperman D, Grant RE. The evaluation of two references for restoring proximal femoral anatomy during total hip arthroplasty. Clin Anat. 2010;23:312–318.PubMed
46.
Zurück zum Zitat Unnanuntana A, Wagner D, Goodman SB. The accuracy of preoperative templating in cementless total hip arthroplasty. J Arthroplasty. 2009;24:180–186.PubMedCrossRef Unnanuntana A, Wagner D, Goodman SB. The accuracy of preoperative templating in cementless total hip arthroplasty. J Arthroplasty. 2009;24:180–186.PubMedCrossRef
Metadaten
Titel
Are the Left and Right Proximal Femurs Symmetric?
verfasst von
Ernest Y. Young, MS
Jeremy Gebhart, BS
Daniel Cooperman, MD
Nicholas U. Ahn, MD
Publikationsdatum
01.05.2013
Verlag
Springer-Verlag
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 5/2013
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2704-x

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